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<p>Mediation analysis is essential for understanding causal mechanisms and designing effective policy interventions. This paper explains a comprehensive framework for implementing VanderWeele’s (2009) three-way decomposition using natural effect models (NEM), focusing on its application in health equity research. While three-way decomposition helps social epidemiologists understand how social exposures influence health outcomes through differential mediator effects, its implementation through NEM has not been fully utilized. Using the R package <i>medflex</i> to implement NEM, we demonstrate the methodology through two case analyses: healthcare expenditure disparities between Medicaid beneficiaries and health insurance enrollees using continuous outcomes, and racial/ethnic disparities in preterm birth using binary outcomes. We provide detailed interpretations of NEM estimates in terms of three-way decomposition and discuss methodological considerations for researchers designing health policies to reduce disparities.</p>

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Three-Way Decomposition for Applied Health Equity Research: A Practical Tutorial to Understand and Address Inequalities

  • 期刊论文

  • 发表日期：

    2025年11月27日

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  • Jin-Hwan Kim,
  • Myoung-Hee Kim,
  • Woojoo Lee

摘要

Mediation analysis is essential for understanding causal mechanisms and designing effective policy interventions. This paper explains a comprehensive framework for implementing VanderWeele’s (2009) three-way decomposition using natural effect models (NEM), focusing on its application in health equity research. While three-way decomposition helps social epidemiologists understand how social exposures influence health outcomes through differential mediator effects, its implementation through NEM has not been fully utilized. Using the R package medflex to implement NEM, we demonstrate the methodology through two case analyses: healthcare expenditure disparities between Medicaid beneficiaries and health insurance enrollees using continuous outcomes, and racial/ethnic disparities in preterm birth using binary outcomes. We provide detailed interpretations of NEM estimates in terms of three-way decomposition and discuss methodological considerations for researchers designing health policies to reduce disparities.