Identification, Inference and Sensitivity Analysis for Causal Mediation Effects

Causal mediation analysis is routinely conducted by applied researchers in a variety of disciplines. The goal of such an analysis is to investigate alternative causal mechanisms by examining the roles of intermediate variables that lie in the causal paths between the treatment and outcome variables. In this paper we first prove that under a particular version of sequential ignorability assumption, the average causal mediation effect (ACME) is nonparametrically identified. We compare our identification assumption with those proposed in the literature. Some practical implications of our identification result are also discussed. In particular, the popular estimator based on the linear structural equation model (LSEM) can be interpreted as an ACME estimator once additional parametric assumptions are made. We show that these assumptions can easily be relaxed within and outside of the LSEM framework and propose simple nonparametric estimation strategies. Second, and perhaps most importantly, we propose a new sensitivity analysis that can be easily implemented by applied researchers within the LSEM framework. Like the existing identifying assumptions, the proposed sequential ignorability assumption may be too strong in many applied settings. Thus, sensitivity analysis is essential in order to examine the robustness of empirical findings to the possible existence of an unmeasured confounder. Finally, we apply the proposed methods to a randomized experiment from political psychology. We also make easy-to-use software available to implement the proposed methods.Comment: Published in at http://dx.doi.org/10.1214/10-STS321 the Statistical Science (http://www.imstat.org/sts/) by the Institute of Mathematical Statistics (http://www.imstat.org

Survivor-complier effects in the presence of selection on treatment, with application to a study of prompt ICU admission

Pre-treatment selection or censoring (`selection on treatment') can occur when two treatment levels are compared ignoring the third option of neither treatment, in `censoring by death' settings where treatment is only defined for those who survive long enough to receive it, or in general in studies where the treatment is only defined for a subset of the population. Unfortunately, the standard instrumental variable (IV) estimand is not defined in the presence of such selection, so we consider estimating a new survivor-complier causal effect. Although this effect is generally not identified under standard IV assumptions, it is possible to construct sharp bounds. We derive these bounds and give a corresponding data-driven sensitivity analysis, along with nonparametric yet efficient estimation methods. Importantly, our approach allows for high-dimensional confounding adjustment, and valid inference even after employing machine learning. Incorporating covariates can tighten bounds dramatically, especially when they are strong predictors of the selection process. We apply the methods in a UK cohort study of critical care patients to examine the mortality effects of prompt admission to the intensive care unit, using ICU bed availability as an instrument

Stronger instruments and refined covariate balance in an observational study of the effectiveness of prompt admission to intensive care units

Instrumental variable methods, subject to appropriate identification assumptions, enable consistent estimation of causal effects in the presence of unobserved confounding. Near–far matching has been proposed as one analytic method to improve inference by strengthening the effect of the instrument on the exposure and balancing observable characteristics between groups of subjects with low and high values of the instrument. However, in settings with hierarchical data (e.g. patients nested within hospitals), or where several covariate interactions must be balanced, conventional near–far matching algorithms may fail to achieve the requisite covariate balance. We develop a new matching algorithm, that combines near–far matching with refined covariate balance, to balance large numbers of nominal covariates while also strengthening the instrumental variable. This extension of near–far matching is motivated by a case-study that aims to identify the causal effect of prompt admission to an intensive care unit on 7-day and 28-day mortality