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. 2023 Jun 5;13:9067. doi: 10.1038/s41598-023-36139-8

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© The Author(s) 2023

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Causal mediation analysis. The total effect of marital status on mortality is represented by path c, whereas the direct effect of marital status on mortality after controlling for the level of chemotherapy/surgery is represented by path c′. The effect of marital status on the level of chemotherapy/surgery is represented by path a; the effect of chemotherapy/surgery on mortality, after controlling for marital status, is represented by path b. The indirect effect of marital status on mortality through chemotherapy/surgery can then be quantified as the product of paths a and b (A). Total, direct, and indirect association of marital status with mortality mediated via chemotherapy/surgery (B). *Breast cancer-specific mortality; ^#overall mortality.