{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:55:46Z","timestamp":1791276946131,"version":"4.1.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"funder":[{"DOI":"10.13039\/100009032","name":"Pfizer UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009032","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infect Dis Ther"],"DOI":"10.1007\/s40121-026-01447-9","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:46:42Z","timestamp":1791276402000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Burden of Disease and Demographics in Older Adults Hospitalized with RSV Infection in England: A Retrospective Cohort Study"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8521-1863","authenticated-orcid":false,"given":"Rebecca","family":"Butfield","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3250-0275","authenticated-orcid":false,"given":"Kiran K.","family":"Rai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7455-4442","authenticated-orcid":false,"given":"Thomas","family":"Jennison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9345-5052","authenticated-orcid":false,"given":"Jack","family":"Said","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8328-7294","authenticated-orcid":false,"given":"Hannah","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1349-7442","authenticated-orcid":false,"given":"Dheeraj","family":"Sethi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9997-167X","authenticated-orcid":false,"given":"Jonathan","family":"Watkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Geneidat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4630-5390","authenticated-orcid":false,"given":"Isabel","family":"Jimenez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6398-7450","authenticated-orcid":false,"given":"Dexter","family":"Wiseman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"issue":"10","key":"1447_CR1","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1136\/thoraxjnl-2018-212212","volume":"74","author":"JA Coultas","year":"2019","unstructured":"Coultas JA, Smyth R, Openshaw PJ. Respiratory syncytial virus (RSV): a scourge from infancy to old age. Thorax. 2019;74(10):986\u201393.","journal-title":"Thorax"},{"key":"1447_CR2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l5021","volume":"366","author":"HH Nam","year":"2019","unstructured":"Nam HH, Ison MG. Respiratory syncytial virus infection in adults. BMJ. 2019;366:l5021.","journal-title":"BMJ"},{"issue":"2","key":"1447_CR3","doi-asserted-by":"publisher","DOI":"10.1111\/irv.13100","volume":"17","author":"A Colosia","year":"2023","unstructured":"Colosia A, Costello J, McQuarrie K, Kato K, Bertzos K. Systematic literature review of the signs and symptoms of respiratory syncytial virus. Influenza Other Respir Viruses. 2023;17(2):e13100.","journal-title":"Influenza Other Respir Viruses"},{"key":"1447_CR4","unstructured":"Agency UHS. Respiratory syncytial virus (RSV): symptoms, transmission, prevention, treatment 2021 [cited 2025 October]. https:\/\/www.gov.uk\/government\/publications\/respiratory-syncytial-virus-rsv-symptoms-transmission-prevention-treatment\/respiratory-syncytial-virus-rsv-symptoms-transmission-prevention-treatment."},{"key":"1447_CR5","unstructured":"Agency UHS. Respiratory syncytial virus: the green book, chapter 27a. 2024 [October 2025]. https:\/\/assets.publishing.service.gov.uk\/media\/686fbfcf2557debd867cbf9d\/Green_Book_Chapter27a_RSV_14July2025.pdf."},{"issue":"3","key":"1447_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2025.106570","volume":"91","author":"R Symes","year":"2023","unstructured":"Symes R, Keddie SH, Walker J, McKeever T, Ahmad S, Arnold D, et al. Burden of respiratory syncytial virus infection in older adults hospitalised in England during 2023\/24. J Infect. 2023;91(3):106570.","journal-title":"J Infect"},{"issue":"2","key":"1447_CR7","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1093\/infdis\/jiad012","volume":"228","author":"C Onwuchekwa","year":"2023","unstructured":"Onwuchekwa C, Moreo LM, Menon S, Machado B, Curcio D, Kalina W, et al. Underascertainment of respiratory syncytial virus infection in adults due to diagnostic testing limitations: a systematic literature review and meta-analysis. J Infect Dis. 2023;228(2):173\u201384.","journal-title":"J Infect Dis"},{"issue":"6","key":"1447_CR8","doi-asserted-by":"publisher","first-page":"1593","DOI":"10.1007\/s40121-023-00805-1","volume":"12","author":"J Ramirez","year":"2023","unstructured":"Ramirez J, Carrico R, Wilde A, Junkins A, Furmanek S, Chandler T, et al. Diagnosis of respiratory syncytial virus in adults substantially increases when adding sputum, saliva, and serology testing to nasopharyngeal swab RT-PCR. Infect Dis Ther. 2023;12(6):1593\u2013603.","journal-title":"Infect Dis Ther"},{"issue":"6","key":"1447_CR9","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1111\/irv.12665","volume":"14","author":"W Cai","year":"2020","unstructured":"Cai W, Tolksdorf K, Hirve S, Schuler E, Zhang W, Haas W, et al. Evaluation of using ICD-10 code data for respiratory syncytial virus surveillance. Influenza Other Respir Viruses. 2020;14(6):630\u20137.","journal-title":"Influenza Other Respir Viruses"},{"issue":"4","key":"1447_CR10","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1093\/infdis\/163.4.693","volume":"163","author":"CB Hall","year":"1991","unstructured":"Hall CB, Walsh EE, Long CE, Schnabel KC. Immunity to and frequency of reinfection with respiratory syncytial virus. J Infect Dis. 1991;163(4):693\u20138.","journal-title":"J Infect Dis"},{"issue":"6-7","key":"1447_CR11","doi-asserted-by":"publisher","DOI":"10.1007\/s00285-021-01681-4","volume":"83","author":"A Le","year":"2021","unstructured":"Le A, King A, Magpantay FMG, Mesbahi A, Rohani P. The impact of infection-derived immunity on disease dynamics. J Math Biol. 2021;83(6\u20137):61.","journal-title":"J Math Biol"},{"key":"1447_CR12","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1007\/s41669-025-00565-3","volume":"9","author":"P Marikic","year":"2025","unstructured":"Marikic P, Kliemt R, Krammer M, Bolb N, Last T, Ambrosch A, et al. Costs and complications of respiratory syncytial virus and acute respiratory infections in the adult population: analysis of a German claims database. PharmacoEcon Open. 2025;9:445\u201359.","journal-title":"PharmacoEcon Open"},{"issue":"3","key":"1447_CR13","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae097","volume":"11","author":"A Averin","year":"2024","unstructured":"Averin A, Atwood M, Sato R, Yacisin K, Begier E, Shea K, et al. Attributable cost of adult respiratory syncytial virus illness beyond the acute phase. Open Forum Infect Dis. 2024;11(3):ofae097.","journal-title":"Open Forum Infect Dis"},{"key":"1447_CR14","unstructured":"UK Government. Respiratory syncytial virus (RSV) immunisation programme for adults aged 80 years and older: JCVI advice, 16 July 2025. 2025. https:\/\/www.gov.uk\/government\/publications\/rsv-immunisation-programme-jcvi-advice-16-july-2025\/respiratory-syncytial-virus-rsv-immunisation-programme-for-adults-aged-80\u00a0years-and-older-jcvi-advice-16-july-2025#conclusions-and-advice."},{"key":"1447_CR15","unstructured":"UK Government. Expansion of RSV vaccine eligibility to those aged 80 years and older and residents in care homes for older adults letter. 2026. https:\/\/www.gov.uk\/government\/publications\/rsv-vaccination-for-older-adults-expansion-of-eligibility\/expansion-of-rsv-vaccine-eligibility-to-those-aged-80\u00a0years-and-older-and-residents-in-care-homes-for-older-adults-letter."},{"key":"1447_CR16","unstructured":"Department of Health and Social Care. RSV immunisation programme: JCVI advice, 18 March 2026. 2026. https:\/\/www.gov.uk\/government\/publications\/rsv-immunisation-programme-jcvi-advice-18-march-2026."},{"key":"1447_CR17","doi-asserted-by":"publisher","DOI":"10.1136\/thorax-2025-224192","author":"T Morelli","year":"2026","unstructured":"Morelli T, Purcell M, Panaguiton J, Patel R, Weinberg S, Hulston G, et al. Understanding risk of poor outcomes in adults hospitalised with respiratory syncytial virus infection: evidence from a multicentre UK cohort. Thorax. 2026. https:\/\/doi.org\/10.1136\/thorax-2025-224192.","journal-title":"Thorax"},{"key":"1447_CR18","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.pcad.2025.06.010","volume":"92","author":"Y Penders","year":"2025","unstructured":"Penders Y, Falsey AR, Bhatt DL, B\u00f6hm M, Coats AJS, Mason LMK, et al. Burden and severity of respiratory syncytial virus infection in adults with cardiovascular diseases: a systematic literature review. Prog Cardiovasc Dis. 2025;92:130\u201343.","journal-title":"Prog Cardiovasc Dis"},{"issue":"1","key":"1447_CR19","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1007\/s11882-025-01194-w","volume":"25","author":"Y Penders","year":"2025","unstructured":"Penders Y, Brusselle G, Falsey AR, Rohde G, Betancur E, Guardado ME, et al. Burden of respiratory syncytial virus disease in adults with asthma and chronic obstructive pulmonary disease: a systematic literature review. Curr Allergy Asthma Rep. 2025;25(1):14.","journal-title":"Curr Allergy Asthma Rep"},{"issue":"6","key":"1447_CR20","doi-asserted-by":"publisher","first-page":"1475","DOI":"10.1016\/j.chest.2021.12.670","volume":"161","author":"J Coussement","year":"2022","unstructured":"Coussement J, Zuber B, Garrigues E, Gros A, Vandueren C, Epaillard N, et al. Characteristics and outcomes of patients in the ICU with respiratory syncytial virus compared with those with influenza infection: a multicenter matched cohort study. Chest. 2022;161(6):1475\u201384.","journal-title":"Chest"},{"key":"1447_CR21","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0160-2025","author":"J Montiel","year":"2026","unstructured":"Montiel J, Williams E, Robles-Rodr\u00edguez WG, Chatzikonstantinidou K, Carri\u00f3 E, Seabroke S, et al. The risk of cardiac disease events after respiratory syncytial virus disease: a systematic literature review and meta-analysis. Eur Respir Rev. 2026. https:\/\/doi.org\/10.1183\/16000617.0160-2025.","journal-title":"Eur Respir Rev"},{"issue":"8","key":"1447_CR22","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1164\/rccm.202308-1320OC","volume":"210","author":"DJ Wiseman","year":"2024","unstructured":"Wiseman DJ, Thwaites RS, Ritchie AI, Finney L, Macleod M, Kamal F, et al. Respiratory syncytial virus-related community chronic obstructive pulmonary disease exacerbations and novel diagnostics: a binational prospective cohort study. Am J Respir Crit Care Med. 2024;210(8):994\u20131001.","journal-title":"Am J Respir Crit Care Med"},{"issue":"3","key":"1447_CR23","doi-asserted-by":"publisher","first-page":"203","DOI":"10.7326\/0003-4819-109-3-203","volume":"109","author":"JA Englund","year":"1988","unstructured":"Englund JA, Sullivan CJ, Jordan MC, Dehner LP, Vercellotti GM, Balfour HH Jr. Respiratory syncytial virus infection in immunocompromised adults. Ann Intern Med. 1988;109(3):203\u20138.","journal-title":"Ann Intern Med"},{"key":"1447_CR24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2024.106347","author":"F Farina","year":"2024","unstructured":"Farina F, Sannipoli D, Diral E, Mastaglio S, Oltolini C, Dell\u2019Acqua R, et al. Impact of respiratory syncytial virus (RSV) on adult haematology oncology patients. J Infect. 2024. https:\/\/doi.org\/10.1016\/j.jinf.2024.106347.","journal-title":"J Infect"},{"key":"1447_CR25","unstructured":"CPRD. Release Notes: CPRD Aurum. December 2024. 2024. https:\/\/www.cprd.com\/doi\/cprd-aurum-december-2024-dataset."},{"key":"1447_CR26","unstructured":"CPRD. HES Admitted Patient Care data. 2025."},{"key":"1447_CR27","unstructured":"CPRD. HES Outpatient data. 2025."},{"key":"1447_CR28","unstructured":"GOV.UK. English indices of deprivation 2019: technical report. 2019. https:\/\/www.gov.uk\/government\/publications\/english-indices-of-deprivation-2019-technical-report."},{"key":"1447_CR29","unstructured":"OpenCodelists. RSV Identification (Primary Care). 2024. https:\/\/www.opencodelists.org\/codelist\/opensafely\/rsv-identification-primary-care\/47b6884f\/."},{"issue":"7","key":"1447_CR30","first-page":"753","volume":"28","author":"M Mesa-Frias","year":"2022","unstructured":"Mesa-Frias M, Rossi C, Emond B, Bookhart B, Anderson D, Drummond S, et al. Incidence and economic burden of respiratory syncytial virus among adults in the United States: a retrospective analysis using 2 insurance claims databases. J Manag Care Spec Pharm. 2022;28(7):753\u201365.","journal-title":"J Manag Care Spec Pharm"},{"issue":"11","key":"1447_CR31","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","volume":"43","author":"H Quan","year":"2005","unstructured":"Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130\u20139.","journal-title":"Med Care"},{"key":"1447_CR32","unstructured":"UK Health Security Agency. Influenza: the green book, chapter 19. 2023. https:\/\/assets.publishing.service.gov.uk\/media\/654cf306014cc90010677371\/Green-book-chapter-19-influenza-_3November2023.pdf."},{"issue":"1","key":"1447_CR33","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2025.2479334","volume":"21","author":"A Puggina","year":"2025","unstructured":"Puggina A, Dovizio M, Domnich A, Marijam A, Veronesi C, Rizzo C, et al. Demographics and clinical burden of disease among RSV-hospitalized older adults in Italy: a retrospective cohort study. Hum Vaccin Immunother. 2025;21(1):2479334.","journal-title":"Hum Vaccin Immunother"},{"key":"1447_CR34","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/590837","volume":"2013","author":"M Pintado","year":"2013","unstructured":"Pintado M, Villa P, Gonzalez-Garcia N, Lujan J, Molina R, Trascasa M, et al. Characteristics and outcomes of elderly patients refused to ICU. Sci World J. 2013;2013:590837.","journal-title":"Sci. World J."},{"issue":"7","key":"1447_CR35","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1007\/s00134-006-0169-7","volume":"32","author":"M Garrouste-Orgeas","year":"2006","unstructured":"Garrouste-Orgeas M, Timsit JF, Montuclard L, Colvez A, Gattolliat O, Philippart F, et al. Decision-making process, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission. Intensive Care Med. 2006;32(7):1045\u201351.","journal-title":"Intensive Care Med"},{"issue":"3","key":"1447_CR36","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.556","volume":"5","author":"E Walsh","year":"2022","unstructured":"Walsh E, Lee N, Sander I, Stolper R, Zakar J, Wyffels V, et al. RSV-associated hospitalization in adults in the USA: a retrospective chart review investigating burden, management strategies, and outcomes. Health Sci Rep. 2022;5(3):e556.","journal-title":"Health Sci Rep"},{"key":"1447_CR37","unstructured":"England PH. Research reveals levels of inappropriate prescriptions in England. 2018. https:\/\/www.gov.uk\/government\/news\/research-reveals-levels-of-inappropriate-prescriptions-in-england."},{"issue":"1","key":"1447_CR38","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1111\/bcp.14651","volume":"87","author":"L Miller","year":"2021","unstructured":"Miller L, Costelloe CE, Robotham JV, Pouwels KB. Overuse of antibiotics: can viral vaccinations help stem the tide? Br J Clin Pharmacol. 2021;87(1):87\u20139.","journal-title":"Br J Clin Pharmacol"},{"key":"1447_CR39","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-015-1218-z","volume":"15","author":"DM Fleming","year":"2015","unstructured":"Fleming DM, Taylor RJ, Lustig RL, Schuck-Paim C, Haguinet F, Webb DJ, et al. Modelling estimates of the burden of respiratory syncytial virus infection in adults and the elderly in the United Kingdom. BMC Infect Dis. 2015;15:443.","journal-title":"BMC Infect Dis"},{"key":"1447_CR40","doi-asserted-by":"publisher","first-page":"90","DOI":"10.12688\/wellcomeopenres.16737.1","volume":"6","author":"A Schultze","year":"2021","unstructured":"Schultze A, Bates C, Cockburn J, MacKenna B, Nightingale E, Curtis HJ, et al. Identifying care home residents in electronic health records\u2014an OpenSAFELY Short Data Report. Wellcome Open Res. 2021;6:90.","journal-title":"Wellcome Open Res"},{"key":"1447_CR41","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens14030284","author":"A Per\u010dini\u0107","year":"2022","unstructured":"Per\u010dini\u0107 A, Vuleti\u0107 T, Lizzul N, Vuki\u0107 Dugac A, Gveri\u0107 Grgini\u0107 A, Tabain I, et al. Epidemiological and clinical characteristics of adult RSV infections: a retrospective analysis at University Hospital Center Zagreb (2022-2024). Pathogens. 2022. https:\/\/doi.org\/10.3390\/pathogens14030284.","journal-title":"Pathogens"},{"key":"1447_CR42","volume":"88","author":"D Guimar\u00e3es de Oliveira","year":"2025","unstructured":"Guimar\u00e3es de Oliveira D, Grande A, Belchior F, Costa R, Francisco R, Oliveira N, et al. Severe respiratory syncytial virus infection in older adults\u2014burden, clinical outcomes and implications for care. Respir Med Res. 2025;88:101173.","journal-title":"Respir Med Res"}],"container-title":["Infectious Diseases and Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40121-026-01447-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40121-026-01447-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40121-026-01447-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:46:48Z","timestamp":1791276408000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40121-026-01447-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":42,"alternative-id":["1447"],"URL":"https:\/\/doi.org\/10.1007\/s40121-026-01447-9","relation":{},"ISSN":["2193-8229","2193-6382"],"issn-type":[{"value":"2193-8229","type":"print"},{"value":"2193-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"assertion":[{"value":"15 July 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Rebecca Butfield, Jack Said and Hannah Wright are employees of Pfizer Ltd and may hold stock or stock options. Kiran Rai, Thomas Jennison, Jon Watkins, Isabel Jimenez and Antonia Geneidat are employees of Adelphi Real\u2010World, which received funds from Pfizer Ltd to conduct this research and for the development of this manuscript. Dexter Wiseman works as a Consultant Respiratory Physician at Chelsea and Westminster NHS Foundation Trust and is an honorary Senior Clinical Lecturer at the National Heart and Lung Institute, Imperial College and was a paid consultant to Pfizer in connection with the development of the study. He has received honoraria from GSK, Sanofi, Pfizer, Janssen and CSL for taking part in advisory boards and expert meetings and for acting as a speaker in congresses outside the scope of the work discussed. Dexter Wiseman is also an editorial board member of\n                      Infectious Diseases and Therapy.\n                      He was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Dheeraj Sethi has no conflicts of interest.","order":1,"name":"Ethics","label":"Conflict of Interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study used existing, fully de-identified data and the subject(s) cannot be identified, directly or through identifiers. Study results were in tabular form and aggregate analyses that omit subject identification. This study was approved by CPRD\u2019s Research Data Governance (RDG) Committee (reference number: 24_004459) to access the data. This study also complied with all applicable laws regarding subject privacy and the Declaration of Helsinki. No direct subject contact or primary collection of individual human subject data has occurred in this study.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}