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  • Mediation Analysis in Eventhistory

    Dear Statalist users,

    I am working with event history data with multiple episodes/recurrent events per individual. My main models are Cox models using stcox. The data are already stset, and I account for multiple episodes per person using clustered standard errors.

    My substantive setup is:

    - independent variable: binary
    - mediator: continuous
    - outcome: event occurrence / survival time
    - data structure: multiple episodes/recurrent events per individual

    My main Cox model is approximately:

    stcox X M controls, vce(cluster id)

    I would like to estimate a mediation effect of X through M on the event outcome.

    I have considered three options:

    1. A pragmatic Cox approach:
    reg M X controls, vce(cluster id)
    stcox X controls, vce(cluster id)
    stcox X M controls, vce(cluster id)

    2. A discrete-time event history approximation using logit and KHB:
    khb logit _d X tgroup controls || M, vce(cluster id)

    3. Survival mediation commands such as paramed or med4way. However, paramed does not seem to support yreg(cox) in my Stata installation, and I am unsure whether med4way is appropriate for recurrent events/multiple episodes.

    My questions are:

    1. Is the discrete-time logit/KHB approach a defensible mediation analysis when the main models are Cox models?
    2. How problematic is it to use KHB on a discrete-time version of the data while reporting Cox models as the main event-history models?
    3. Is there a recommended Stata approach for mediation analysis with Cox models and recurrent events?
    4. Would med4way be appropriate in this setting, or is it mainly suitable for single-event survival outcomes?

    Any guidance or references would be greatly appreciated.

    Best,
    Julia
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