Estimation and sensitivity analysis for causal decomposition in health disparity research

In the field of disparities research, there has been growing interest in developing a counterfactual-based decomposition analysis to identify underlying mediating mechanisms that help reduce disparities in populations. Despite rapid development in the area, most prior studies have been limited to regression-based methods, undermining the possibility of addressing complex models with multiple mediators and/or heterogeneous effects. We propose a novel estimation method that effectively addresses complex models. Moreover, we develop a sensitivity analysis for possible violations of an identification assumption. The proposed method and sensitivity analysis are demonstrated with data from the Midlife Development in the US study to investigate the degree to which disparities in cardiovascular health at the intersection of race and gender would be reduced if the distributions of education and perceived discrimination were the same across intersectional groups.