{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T23:58:08Z","timestamp":1762300688638,"version":"build-2065373602"},"reference-count":36,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T00:00:00Z","timestamp":1713398400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["U01 NS041588"],"award-info":[{"award-number":["U01 NS041588"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["T32 HL155007"],"award-info":[{"award-number":["T32 HL155007"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Statistics in Medicine"],"published-print":{"date-parts":[[2024,6,15]]},"abstract":"<jats:p>Mediation analysis is an increasingly popular statistical method for explaining causal pathways to inform intervention. While methods have increased, there is still a dearth of robust mediation methods for count outcomes with excess zeroes. Current mediation methods addressing this issue are computationally intensive, biased, or challenging to interpret. To overcome these limitations, we propose a new mediation methodology for zero\u2010inflated count outcomes using the marginalized zero\u2010inflated Poisson (MZIP) model and the counterfactual approach to mediation. This novel work gives population\u2010average mediation effects whose variance can be estimated rapidly via delta method. This methodology is extended to cases with exposure\u2010mediator interactions. We apply this novel methodology to explore if diabetes diagnosis can explain BMI differences in healthcare utilization and test model performance via simulations comparing the proposed MZIP method to existing zero\u2010inflated and Poisson methods. We find that our proposed method minimizes bias and computation time compared to alternative approaches while allowing for straight\u2010forward interpretations.<\/jats:p>","DOI":"10.1002\/sim.10085","type":"journal-article","created":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T22:53:38Z","timestamp":1713480818000},"page":"2547-2559","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Population\u2010average mediation analysis for zero\u2010inflated count outcomes"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8525-4381","authenticated-orcid":false,"given":"Andrew","family":"Sims","sequence":"first","affiliation":[{"name":"Department of Biostatistics, Ryals Public Health Building (RPHB) University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"Department of Medicine University of Mississippi Medical Center  Jackson Mississippi USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. Leann","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Ryals Public Health Building (RPHB) University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"Department of Biostatistics and Data Science, School of Medicine Wake Forest University  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hemant K.","family":"Tiwari","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Ryals Public Health Building (RPHB) University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinhong","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Ryals Public Health Building (RPHB) University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dustin M.","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Ryals Public Health Building (RPHB) University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"Department of Biostatistics and Data Science, School of Medicine Wake Forest University  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd M.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa J.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Ryals Public Health Building (RPHB) University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily B.","family":"Levitan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Ryals Public Health Building (RPHB) University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,4,18]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1214\/11-AOAS534"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/5353539"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6314"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1159\/000338992"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.2307\/1269547"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-4076(86)90002-3"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010publhealth\u2010032315\u2010021402"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280216686131"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.5380"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0020761"},{"volume-title":"Explanation in Causal Inference: Methods for Mediation and Interaction","year":"2016","author":"VanderWeele T","key":"e_1_2_12_12_1"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6293"},{"key":"e_1_2_12_14_1","unstructured":"PearlJ.Direct and Indirect Effects. 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