High-dimensional mediation analysis for longitudinal mediators and survival outcomes.

Mediation analysis with high-dimensional mediators is crucial for identifying epigenetic pathways linking environmental exposures to health outcomes. However, high-dimensional mediation analysis methods for longitudinal mediators and a survival outcome remain underdeveloped. This study fills that gap by introducing a method that captures mediation effects over time using multivariate, longitudinally measured time-varying mediators. Our approach uses a longitudinal mixed effects model to examine the relationship between the exposure and the mediating process. We connect the mediating process to the survival outcome using a Cox proportional hazards model with time-varying mediators. To handle high-dimensional data, we first employ a mediation-based sure independence screening method for dimension reduction. A Lasso inference procedure is further utilized to identify significant time-varying mediators. We adopt a joint significance test to accurately control the family wise error rate in testing high-dimensional mediation hypotheses. Simulation studies and an analysis of the Coronary Artery Risk Development in Young Adults Study demonstrate the utility and validity of our method.