多种因素的调节可以影响邻里剥夺和隔离指数与卵巢癌生存之间的关系。在本文中，我们在非裔美国人癌症流行病学研究 (AACES) 中研究了剥夺指数 (DI) 和隔离指数 (SI) 与卵巢癌女性全因生存率之间关系的各种潜在临床中介因素。我们使用新颖的贝叶斯多重中介结构模型，用于评估中介因素（诊断阶段、组织学、诊断延迟）与 DI 和 SI（Yost、ADI、Kolak 的 URB、ICE-收入）以及一组与生存的混杂因素相结合的联合作用。在初步步骤中选择混杂因素集，并将每个 DI 或 SI 包含在单独的模型拟合中。当包含多个中介时，DI 和 SI 对生存的总影响会大大降低。与之前报道的单一中介例子不同，Yost、ADI 和 ICE 收入指数没有显示出显着的直接影响。这表明，当纳入重要的临床中介因素时，邻近 SES 指数的影响会显着减弱。同样明显的是，某些行为和人口统计指标，如体力活动、吸烟或调整后的家庭收入，在临床因素介导下对生存没有显着影响。通过临床和诊断相关指标的多重中介可减少邻里的背景影响卵巢癌生存的措施。 Kolak URB 指数与生存率之间的紧密关联可能是由于其与获得护理的相关性，这与基于 SES 的指数不同，当纳入重要的临床介质时，后者的影响会显着降低。版权所有 © 2024。由 Elsevier Inc. 出版。

Mediation by multiple agents can affect the relation between neighborhood deprivation and segregation indices and ovarian cancer survival. In this paper, we examine a variety of potential clinical mediators in the association between deprivation indices (DIs) and segregation indices (SIs) with all-cause survival among women with ovarian cancer in the African American Cancer Epidemiology Study (AACES).We use novel Bayesian multiple mediation structural models to assess the joint role of mediators (stage at diagnosis, histology, diagnostic delay) combined with the DIs and SIs (Yost, ADI, Kolak's URB, ICE-income) and a set of confounders with survival. The confounder set is selected in a preliminary step, and each DI or SI is included in separate model fits.When multiple mediators are included, the total impact of DIs and SIs on survival is much reduced. Unlike the single mediator examples previously reported, the Yost, ADI and ICE-income indices do not display significant direct effects. This suggests that when important clinical mediators are included, the impact of neighborhood SES indices is significantly attenuated. It is also clear that certain behavioral and demographic measures such as physical activity, smoking, or adjusted family income do not have a significant role in survival when mediated by clinical factors.Multiple mediation via clinical and diagnostic-related measures reduces the contextual effects of neighborhood measures on ovarian cancer survival. The robust association of the Kolak URB index on survival may be due to its relevance to access to care, unlike SES-based indices whose impact was significantly reduced when important clinical mediators were included.Copyright © 2024. Published by Elsevier Inc.