In Reply We are grateful for the opportunity to respond to the issues raised by Ilango and Shaffer and Inoue and colleagues. We would like to express our appreciation for their interest in our study.1
In their letters, Ilango and Shaffer and Inoue and colleagues questioned whether some of the assumptions required for conducting mediation analysis using structural equation modeling are met in our study.1 In fact, key assumptions are needed for the estimates of direct and indirect effects to be interpreted causally2: (1) the mediators do not affect one another, (2) exposure-mediators interactions are absent, and (3) mediator-outcome confounders affected by the exposure are absent.
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Rizzuto D, Grande G, Bellavia A. Air Pollution, Cardiovascular Disease, and Dementia—Reply. JAMA Neurol. 2020;77(12):1581–1582. doi:10.1001/jamaneurol.2020.4312
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