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. 2018 Jun;2(2):e015.
doi: 10.1097/EE9.0000000000000015. Epub 2018 May 30.

Multiple mediators approach to study environmental chemicals as determinants of health disparities

Andrea Bellavia  1   2 , Ami R Zota  3 , Linda Valeri  4   5 , Tamarra James-Todd  1   6   7
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Multiple mediators approach to study environmental chemicals as determinants of health disparities

Andrea Bellavia et al. Environ Epidemiol. 2018 Jun.

Abstract

A major goal of health disparities research is to identify and intervene upon modifiable risk factors that help explain the observed associations between social factors and adverse health outcomes. To this end, statistical methods incorporating mediation analysis have shown promise, as they quantify the contribution of an intermediate variable in an exposure-outcome association. A growing body of literature suggests that environmental chemicals can contribute to health disparities. However, evaluating environmental chemicals as an important component of health disparities introduces methodological complexities that may make standard mediation approaches inadequate. Specific to environmental health is the issue of evaluating both the source and biomarker of the environmental toxicant in order to calculate the proportion of the disparity that would remain had we intervened on the modifiable factors. Recent methodological developments on multiple mediators can improve efforts to integrate both source and biomarker of exposure into epidemiological studies of health disparities. We illustrate a conceptual framework and present how mediation techniques can be used to address environmental health disparities questions. With this, we provide a methodological tool that has the potential to advance this growing field, while simultaneously informing public health prevention and policy surrounding the impact of environmental factors on health disparities.

Keywords: Health disparities; behavior; biomarkers; environmental chemicals; mediation; race; social determinants of health.

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Conflict of interest statement

Conflict of interest: nothing to declare

Figures

Figure.
Figure.
Conceptual model to describe environmental health disparities. The figure describes the contribution of an environmental factor (E) and its modifiable source (B) in the health disparity X-Y, where X is an immutable or difficult to modify social factor (e.g., race/ethnicity, gender, SES) and Y the health outcome known to be unequally distributed across subgroups of X.
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