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Mediation analysis with a time-to-event outcome: a review of use and reporting in healthcare research
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Mediation analysis with a time-to-event outcome: a review of use and reporting in healthcare research
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Journal Article
Mediation analysis with a time-to-event outcome: a review of use and reporting in healthcare research
2018
Overview
Background
Mediation analysis tests whether the relationship between two variables is explained by a third intermediate variable. We sought to describe the usage and reporting of mediation analysis with time-to-event outcomes in published healthcare research.
Methods
A systematic search of Medline, Embase, and Web of Science was executed in December 2016 to identify applications of mediation analysis to healthcare research involving a clinically relevant time-to-event outcome. We summarized usage over time and reporting of important methodological characteristics.
Results
We included 149 primary studies, published from 1997 to 2016. Most studies were published after 2011 (
n
= 110, 74%), and the annual number of studies nearly doubled in the last year (from
n
= 21 to
n
= 40). A traditional approach (causal steps or change in coefficient) was most commonly taken (
n
= 87, 58%), and the majority of studies (
n
= 114, 77%) used a Cox Proportional Hazards regression for the outcome. Few studies (
n
= 52, 35%) mentioned any of the assumptions or limitations fundamental to a causal interpretation of mediation analysis.
Conclusion
There is increasing use of mediation analysis with time-to-event outcomes. Current usage is limited by reliance on traditional methods and the Cox Proportional Hazards model, as well as low rates of reporting of underlying assumptions. There is a need for formal criteria to aid authors, reviewers, and readers reporting or appraising such studies.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
Subject
/ Data Interpretation, Statistical
/ Delivery of Health Care - methods
/ Delivery of Health Care - statistics & numerical data
/ Effect Modifier, Epidemiologic
/ Health Services Research - methods
/ Health Services Research - statistics & numerical data
/ Humans
/ Mediating effects (Research)
/ Mediation analysis, Survival, Time-to-event, Methodology
/ Medicine
/ Methods
/ Outcome and process assessment (Health Care)
/ Outcome Assessment (Health Care) - methods
/ Outcome Assessment (Health Care) - statistics & numerical data
/ Pain
/ Statistical Theory and Methods
/ Statistics for Life Sciences
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