Nonparametric estimation of the interventional disparity indirect effect among the exposed

Abstract: In situations with non-manipulable exposures, interventions can be targeted to shift the distribution of intermediate variables between exposure groups to define interventional disparity indirect effects. In this work, we present a theoretical study of identification and nonparametric estimation of the interventional disparity indirect effect among the exposed. The targeted estimand is intended for applications examining the outcome risk among an exposed population for which the risk is expected to be reduced if the distribution of a mediating variable was changed by a (hypothetical) policy or health intervention that targets the exposed population specifically. We derive the nonparametric efficient influence function, study its double robustness properties and present a targeted minimum loss-based estimation (TMLE) procedure. All theoretical results and algorithms are provided for both uncensored and right-censored survival outcomes. With offset in the ongoing discussion of the interpretation of non-manipulable exposures, we discuss relevant interpretations of the estimand under different sets of assumptions of no unmeasured confounding and provide a comparison of our estimand to other related estimands within the framework of interventional (disparity) effects. Small-sample performance and double robustness properties of our estimation procedure are investigated and illustrated in a simulation study.