ArticleBMJ open2017
Sensitivity analysis for mistakenly adjusting for mediators in estimating total effect in observational studies.
Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 3 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 3 syntheses or guidelines pooled it.
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- Road Traffic Noise Exposure and Depression/Anxiety: An Updated Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2019Pooled it
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- The Impact of Waitlisting After a Weekend on Transplant-Related Outcomes for Patients With Acute Liver Failure in the US.JGH open : an open access journal of gastroenterology and hepatology · 2025Article
- Prehospital versus emergency department noninvasive ventilation: oxygen, outcomes, and mediator.European journal of emergency medicine : official journal of the European Society for Emergency Medicine · 2025Article
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- Infertility treatment associated with childhood asthma and atopy.Human reproduction (Oxford, England) · 2022Article
- High-Dimensional DNA Methylation Mediates the Effect of Smoking on Crohn's Disease.Frontiers in genetics · 2022Article
- Childhood maltreatment and disordered eating attitudes and behaviors in adult men and women:Findings from project EAT.Appetite · 2021Article
- Mortality among individuals exposed to atomic bomb radiation in utero: 1950-2012.European journal of epidemiology · 2021Article
- Histologic chorioamnionitis and risk of neurodevelopmental impairment at age 10 years among extremely preterm infants born before 28 weeks of gestation.American journal of obstetrics and gynecology · 2020Observational
- Urinary Excretion ofNutrients · 2020Article
- Adverse maternal and neonatal outcomes among women with preeclampsia with severe features <34 weeks gestation with versus without comorbidity.Pregnancy hypertension · 2020Article
- DNA Repair Biomarker for Lung Cancer Risk and its Correlation With Airway Cells Gene Expression.JNCI cancer spectrum · 2020Article
- Nighttime environmental noise and semen quality: A single fertility center cohort study.PloS one · 2020Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesIn observational studies, epidemiologists often attempt to estimate the total effect of an exposure on an outcome of interest. However, when the underlying diagram is unknown and limited knowledge is available, dissecting bias performances is essential to estimating the total effect of an exposure on an outcome when mistakenly adjusting for mediators under logistic regression. Through simulation, we focused on six causal diagrams concerning different roles of mediators. Sensitivity analysis was conducted to assess the bias performances of varying across exposure-mediator effects and mediator-outcome effects when adjusting for the mediator.
settingBased on the causal relationships in the real world, we compared the biases of varying across the effects of exposure-mediator with those of varying across the effects of mediator-outcome when adjusting for the mediator. The magnitude of the bias was defined by the difference between the estimated effect (using logistic regression) and the total effect of the exposure on the outcome.
resultsIn four scenarios (a single mediator, two series mediators, two independent parallel mediators or two correlated parallel mediators), the biases of varying across the effects of exposure-mediator were greater than those of varying across the effects of mediator-outcome when adjusting for the mediator. In contrast, in two other scenarios (a single mediator or two independent parallel mediators in the presence of unobserved confounders), the biases of varying across the effects of exposure-mediator were less than those of varying across the effects of mediator-outcome when adjusting for the mediator.
conclusionsThe biases were more sensitive to the variation of effects of exposure-mediator than the effects of mediator-outcome when adjusting for the mediator in the absence of unobserved confounders, while the biases were more sensitive to the variation of effects of mediator-outcome than those of exposure-mediator in the presence of an unobserved confounder.
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