The estimation of direct effects and indirect effects (via one or several mediators) of an exposure on survival is a challenging task, that has received much attention lately. A good overview is given by Aalen et al. (2012). They emphazise the importance of explicitly including time in any discussion of causality and mediation: A cause must precede an effect. And many relevant references are found there.

Relevant, recent material


Aalen, O.O., K. Røysland, J.M. Gran, and B. Ledergerber. 2012. “Causality, Mediation and Time: A Dynamic Viewpoint.” Journal of the Royal Statistical Society Series A 175: 831–61. doi:10.1111/j.1467-985X.2011.01030.x.

Broström, G., and S. Edvinsson. 2013. “A Parametric Model for Old Age Mortality in Mediation Analysis.”

Edvinsson, S., and G. Broström. 2013. “The Effect of Early-Life and Mid-Life Factors on Old Age Mortality.”

Lange, T., and J. Hansen. 2011. “Direct and Indirect Effects in a Survival Context.” Epidemiology 22: 575–81. doi:10.1097/EDE.0b013e31821c680c.

Lange, T., S. Vansteelandt, and M. Bekaert. 2012. “A Simple Unified Approach for Estimating Natural Direct and Indirect Effects.” American Journal of Epidemiology 176: 190–95. doi:10.1093/aje/kwr525.

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