ArticleEpidemiology (Cambridge, Mass.)2016
Comparing Alternative Effect Decomposition Methods: The Role of Literacy in Mediating Educational Effects on Mortality.
Article in Epidemiology (Cambridge, Mass.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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13 citing papers in PubMed.
- Burden of hypertension and type 2 diabetes in Tamale Metropolis: a case study of Tamale teaching hospital.BMC public health · 2025Article
- Do health literacy, physical health and past rehabilitation utilization explain educational differences in the subjective need for medical rehabilitation? Results of the lidA cohort study.BMC public health · 2024Article
- Evaluating interpersonal discrimination and depressive symptoms as partial mediators of the effects of education on cognition: Evidence from the Study of Healthy Aging in African Americans (STAR).Alzheimer's & dementia : the journal of the Alzheimer's Association · 2023Article
- To what extent do social support and mastery mediate the association between childhood maltreatment and depression? A sequential causal mediation analysis.Epidemiology and psychiatric sciences · 2022Article
- Alcohol Use and Blood Pressure Among Adults with Hypertension: the Mediating Roles of Health Behaviors.Journal of general internal medicine · 2022Article
- Social inequalities in early exit from employment in Germany: a causal mediation analysis on the role of work, health, and work ability.Scandinavian journal of work, environment & health · 2022Article
- Working conditions and health behavior as causes of educational inequalities in self-rated health: an inverse odds weighting approach.Scandinavian journal of work, environment & health · 2021Article
- School performance and mortality: The mediating role of educational attainment and work and family trajectories across the life course.Advances in life course research · 2020Article
- Inequalities in elevated depressive symptoms in middle-aged and older adults by rural childhood residence: The important role of education.International journal of geriatric psychiatry · 2019Article
- Educational attainment and cardiovascular disease in the United States: A quasi-experimental instrumental variables analysis.PLoS medicine · 2019Article
- The role of literacy in the association between educational attainment and depressive symptoms.SSM - population health · 2017Article
- Effect modification, interaction and mediation: an overview of theoretical insights for clinical investigators.Clinical epidemiology · 2017Article
- The Consistency Assumption for Causal Inference in Social Epidemiology: When a Rose is Not a Rose.Current epidemiology reports · 2016Article
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Abstract
backgroundInverse odds ratio weighting, a newly proposed tool to evaluate mediation in exposure-disease associations, may be valuable for a host of research questions, but little is known about its performance in real data. We compare this approach to a more conventional Baron and Kenny type of decomposition on an additive hazards scale to estimate total, direct, and indirect effects using the example of the role of literacy in mediating the effects of education on mortality.
methodsHealth and Retirement Study participants born in the United States between 1900 and 1947 were interviewed biennially for up to 12 years (N = 17,054). Literacy was measured with a brief vocabulary assessment. Decomposition estimates were derived based on Aalen additive hazards models.
resultsA 1 standard deviation difference in educational attainment (3 years) was associated with 6.7 fewer deaths per 1000 person-years (β = -6.7, 95% confidence interval [CI]: -7.9, -5.4). Of this decrease, 1.3 fewer deaths (β = -1.3, 95% CI: -4.0, 1.2) were attributed to the literacy pathway (natural indirect), representing 19% of the total effect. Baron and Kenny estimates were consistent with inverse odds ratio weighting estimates but were less variable (natural indirect effect: -1.2 [95% CI: -1.7, -0.69], representing 18% of total effect).
conclusionIn a cohort of older Americans, literacy partially mediated the effect of education on mortality. See Video Abstract at http://links.lww.com/EDE/B78.
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