Proximal Path-Specific Inference

Mediation analysis (Robins & Greenland 1992, Pearl 2001, Imai, Keele & Tingley 2010, Tchetgen Tchetgen & Shpitser 2012) provides a principled framework for investigating causal mechanisms by decomposing the effect of a treatment A on an outcome Y into pathways operating through a mediator of interest M. Classical mediation analysis focuses on the natural indirect effect, corresponding to the pathway from Ato Y through M, and the natural direct effect, corresponding to pathways not through M. These estimands are well understood when a single mediator is present and strong identification assumptions hold. However, in many applications, there exist multiple intermediate variables between treatment and outcome. In such settings, conventional mediation analysis typically requires the absence of treatment-induced mediator-outcome confounders--often referred to as recanting witnesses--as well as the absence of unmeasured confounding. Under these circumstances, commonly used identification assumptions such as sequential ignorability (Imai, Keele & Yamamoto 2010) or nonparametric structural equation models with independent errors (NPSEM-IE) (Pearl 2009) no longer suffice to identify natural indirect effects (Avin et al. 2005, Tchetgen Tchetgen & VanderWeele 2014). Figure 1 illustrates this issue: the recanting witness D is directly affected by A and simultaneously confounds the relationship between M and Y. Such treatment-induced confounding is common in epidemiologic studies, particularly when the mediator of interest occurs long after the treatment initiation (Robins 1999). A motivating example arises in studies of preterm birth. Mediation analysis has been widely used to explore whether adequate prenatal care (A) reduces the risk of preterm birth (Y) through preeclampsia (M) (Vansteelandt & VanderWeele 2012, VanderWeele et al. 2014, Xia & Chan 2023).