Lange Theis, Hansen Kim Wadt, Sørensen Rikke, Galatius Søren
Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
Center for Statistical Science, Peking University, Copenhagen, Denmark.
Epidemiol Health. 2017 Aug 6;39:e2017035. doi: 10.4178/epih.e2017035. eCollection 2017.
In recent years, mediation analysis has emerged as a powerful tool to disentangle causal pathways from an exposure/treatment to clinically relevant outcomes. Mediation analysis has been applied in scientific fields as diverse as labour market relations and randomized clinical trials of heart disease treatments. In parallel to these applications, the underlying mathematical theory and computer tools have been refined. This combined review and tutorial will introduce the reader to modern mediation analysis including: the mathematical framework; required assumptions; and software implementation in the R package medflex. All results are illustrated using a recent study on the causal pathways stemming from the early invasive treatment of acute coronary syndrome, for which the rich Danish population registers allow us to follow patients' medication use and more after being discharged from hospital.
近年来，中介分析已成为一种强大的工具，用于理清从暴露/治疗到临床相关结局的因果路径。中介分析已应用于诸如劳动力市场关系和心脏病治疗随机临床试验等多个科学领域。与这些应用并行的是，基础数学理论和计算机工具也得到了完善。这篇综述与教程相结合的文章将向读者介绍现代中介分析，包括：数学框架；所需假设；以及R包medflex中的软件实现。所有结果都通过一项关于急性冠状动脉综合征早期侵入性治疗因果路径的最新研究进行说明，丹麦丰富的人口登记数据使我们能够跟踪患者出院后的用药情况及更多信息。
