{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T11:20:02Z","timestamp":1773832802694,"version":"3.50.1"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T00:00:00Z","timestamp":1727049600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T00:00:00Z","timestamp":1727049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J. Racial and Ethnic Health Disparities"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>The primary objective of this cross-sectional study is to investigate the association between vitamin D deficiency (VDD) and diabetes and see if this association is the same for adult (age\u2009\u2265\u200920) African Americans (AAs) and Whites. The secondary objective is to examine the distribution of the 25-hydroxyvitamin D test among AAs and Whites and to evaluate the appropriateness of using the same cut-off point for both groups to diagnose VDD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Our analysis is based on the 2011\u20132014 National Health and Nutrition Examination Surveys (NHANES). We used two common propensity score adjustment methods to analyze the data\u2014propensity score matching (PSM) and the inverse probability of treatment weighting (IPTW).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The prevalence of diabetes for AAs and Whites was 12.27% (95% CI, 10.47\u201314.07%) and 7.24% (95% CI, 6.35\u20138.13%), respectively. The prevalence of VDD for AAs and Whites was 65.29% (95% CI, 62.01\u201368.58%) and 19.49% (95% CI, 16.53\u201322.45%), respectively. Under PSM, the odds ratios for the diabetes-VDD association for AAs and Whites were 0.94 (95% CI, 0.70\u20131.27) and 2.16 (95% CI, 1.49\u20133.13), respectively. Under IPTW, the VDD-diabetes odds ratios for AAs and Whites were 0.83 (95% CI, 0.64\u20131.10) and 2.35 (95% CI, 1.67\u20133.30), respectively. Our results further demonstrate that the 25-hydroxyvitamin D measurements are significantly different for AAs and Whites across the general population, as well as the vitamin D\u2013sufficient and vitamin D\u2013deficient populations.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The prevalence of VDD and diabetes was higher for AAs compared to Whites. However, VDD was associated with increased diabetes risk for Whites but not for AAs. Though more research is needed to explain why this is the case, a reason for this may be that the 25-hydroxyvitamin D test or its associated cut-off point for defining VDD may not accurately reflect the vitamin D status among AAs.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s40615-024-02144-4","type":"journal-article","created":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T05:32:42Z","timestamp":1727155962000},"page":"3401-3416","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Association Between Vitamin D Deficiency and Diabetes in Adult African Americans and Whites: An NHANES Study"],"prefix":"10.1007","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1666-7072","authenticated-orcid":false,"given":"Alula","family":"Hadgu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fengxia","family":"Yan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Mayberry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,9,23]]},"reference":[{"issue":"6","key":"2144_CR1","doi-asserted-by":"publisher","first-page":"9941004","DOI":"10.2337\/dci18-0047","volume":"42","author":"CC Cowie","year":"2019","unstructured":"Cowie CC. Diabetes diagnosis and control: missed opportunities to improve health. Diabetes Care. 2019;42(6):9941004.","journal-title":"Diabetes Care"},{"key":"2144_CR2","unstructured":"CDC, National Statistics Report, 2017: estimates of diabetes and its burdens in the United States."},{"key":"2144_CR3","unstructured":"CDC, \u201cData & Research.\u201d U.S. Department of Health and Human Services, 2024. https:\/\/www.cdc.gov\/diabetes\/php\/data-research\/index.html."},{"key":"2144_CR4","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/1478-7954-8-29","volume":"8","author":"JP Boyle","year":"2010","unstructured":"Boyle JP, Thompson TJ, Gregg EW, et al. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metrics. 2010;8:29.","journal-title":"Popul Health Metrics"},{"issue":"1","key":"2144_CR5","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s11892-020-01369-x","volume":"21","author":"JS Haw","year":"2021","unstructured":"Haw JS, Shah M, Turbow S, et al. Diabetes complications in racial and ethnic minority populations in the USA. Curr Diab Rep. 2021;21(1):3.","journal-title":"Curr Diab Rep"},{"key":"2144_CR6","unstructured":"CDC, National Center for Environmental Health, Division of Laboratory Sciences Report: Second National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population. 2012."},{"issue":"1","key":"2144_CR7","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.nutres.2010.12.001","volume":"31","author":"KY Forrest","year":"2011","unstructured":"Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011;31(1):48\u201354.","journal-title":"Nutr Res"},{"issue":"Suppl 6","key":"2144_CR8","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s12919-018-0102-4","volume":"12","author":"LL Brown","year":"2018","unstructured":"Brown LL, Cohen B, Tabor D, Zappal\u00e0 G, Maruvada P, Coates PM. The vitamin D paradox in Black Americans: a systems-based approach to investigating clinical practice, research, and public health - expert panel meeting report. BMC Proc. 2018;12(Suppl 6):6.","journal-title":"BMC Proc"},{"issue":"10","key":"2144_CR9","doi-asserted-by":"publisher","first-page":"1746","DOI":"10.2105\/AJPH.2006.091736","volume":"97","author":"K Rajakumar","year":"2007","unstructured":"Rajakumar K, Greenspan SL, Thomas SB, Holick MF. SOLAR ultraviolet radiation and vitamin D: a historical perspective. Am J Public Health. 2007;97(10):1746\u201354.","journal-title":"Am J Public Health"},{"key":"2144_CR10","unstructured":"National Institute of Diabetes and Digestive and Kidney Diseases: Lactose intolerance, 2010 [article online]. Available from http:\/\/ digestive.niddk.nih.gov\/ddiseases\/pubs\/ lactose intolerance"},{"issue":"3","key":"2144_CR11","doi-asserted-by":"publisher","first-page":"148","DOI":"10.2337\/diaspect.24.3.148","volume":"24","author":"SV Davis","year":"2011","unstructured":"Davis SV. Vitamin D deficiency and type 2 diabetes in African Americans: the common denominators. Diabetes Spectr. 2011;24(3):148\u201353.","journal-title":"Diabetes Spectr"},{"issue":"8","key":"2144_CR12","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1042\/BCJ20170042","volume":"474","author":"MJ Berridge","year":"2017","unstructured":"Berridge MJ. Vitamin D deficiency and diabetes. Biochm J. 2017;474(8):1321\u201332.","journal-title":"Biochm J"},{"issue":"3","key":"2144_CR13","doi-asserted-by":"publisher","first-page":"650","DOI":"10.2337\/diacare.29.03.06.dc05-1961","volume":"29","author":"Anastassios G Pittas","year":"2006","unstructured":"Pittas Anastassios G, Dawson-Hughes Bess, Li Tricia, Van Dam Rob M, Willett Walter C, Manson Joann E, Hu Frank B. Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes Care. 2006;29(3):650\u20136.","journal-title":"Diabetes Care"},{"issue":"12","key":"2144_CR14","doi-asserted-by":"publisher","first-page":"2813","DOI":"10.2337\/diacare.27.12.2813","volume":"27","author":"R Scragg","year":"2004","unstructured":"Scragg R, Sowers M, Bell C, Health Third National, Survey Nutrition Examination. Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the Third National Health and Nutrition Examination Survey. Diabetes Care. 2004;27(12):2813\u20138.","journal-title":"Diabetes Care"},{"issue":"6","key":"2144_CR15","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.2337\/dc09-2321","volume":"33","author":"S Kayaniyil","year":"2010","unstructured":"Kayaniyil S, Vieth R, Retnakaran R, Knight JA, Qi Y, Gerstein HC, Perkins BA, Harris SB, Zinman B, Hanley AJ. Association of vitamin D with insulin resistance and beta-cell dysfunction in subjects at risk for type 2 diabetes. Diabetes Care. 2010;33(6):1379\u201381.","journal-title":"Diabetes Care"},{"issue":"4","key":"2144_CR16","doi-asserted-by":"publisher","first-page":"e0193070","DOI":"10.1371\/journal.pone.0193070","volume":"13","author":"SK Park","year":"2018","unstructured":"Park SK, Garland CF, Gorham ED, BuDoff L, Barrett-Connor E. Plasma 25-hydroxyvitamin D concentration and risk of type 2 diabetes and pre-diabetes: 12-year cohort study. PLoS ONE. 2018;13(4):e0193070.","journal-title":"PLoS ONE"},{"key":"2144_CR17","doi-asserted-by":"publisher","first-page":"3200","DOI":"10.1210\/jc.2009-0445","volume":"94","author":"A Ashraf","year":"2009","unstructured":"Ashraf A, Alvarez J, Saenz K, Gower B, McCormick K, Franklin F. Threshold for effects of vitamin D deficiency on glucose metabolism in obese female African American adolescents. J Clin Endocrinol Metab. 2009;94:3200\u20136.","journal-title":"J Clin Endocrinol Metab"},{"issue":"10","key":"2144_CR18","doi-asserted-by":"publisher","first-page":"3551","DOI":"10.1210\/jc.2014-2136","volume":"99","author":"JC Seida","year":"2014","unstructured":"Seida JC, Mitri J, Colmers IN, Majumdar SR, Davidson MB, Edwards AL, Hanley DA, Pittas AG, Tjosvold L, Johnson JA. Clinical review: Effect of vitamin D3 supplementation on improving glucose homeostasis and preventing diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2014;99(10):3551\u201360.","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2144_CR19","doi-asserted-by":"publisher","first-page":"2017","DOI":"10.1210\/jc.2007-0298","volume":"92","author":"AG Pittas","year":"2007","unstructured":"Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes A systematic review and meta-analysis. J Clin Endocrinol Metab. 2007;92(6):2017\u201329.","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"2144_CR20","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1530\/EJE-19-0156","volume":"181","author":"P Lemieux","year":"2019","unstructured":"Lemieux P, Weisnagel SJ, Caron AZ, Julien AS, Morisset AS, Carreau AM, Poirier J, Tchernof A, Robitaille J, Bergeron J, Marette A, Vohl MC, Gagnon C. Effects of 6-month vitamin D supplementation on insulin sensitivity and secretion: a randomized, placebo-controlled trial. Eur J Endocrinol. 2019;181(3):287\u201399.","journal-title":"Eur J Endocrinol"},{"issue":"6","key":"2144_CR21","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1056\/NEJMoa1900906","volume":"381","author":"AG Pittas","year":"2019","unstructured":"Pittas AG, Dawson-Hughes B, Sheehan P, Ware JH, Knowler WC, Aroda VR, Brodsky I, Ceglia L, Chadha C, Chatterjee R, Desouza C, Dolor R, Foreyt J, Fuss P, Ghazi A, Hsia DS, Johnson KC, Kashyap SR, Kim S, LeBlanc ES, Lewis MR, Liao E, Neff LM, Nelson J, O\u2019Neil P, Park J, Peters A, Phillips LS, Pratley R, Raskin P, Rasouli N, Robbins D, Rosen C, Vickery EM, Staten M, D2d Research Group. Vitamin D supplementation and prevention of type 2 diabetes. N Engl J Med. 2019;381(6):520\u201330.","journal-title":"N Engl J Med"},{"key":"2144_CR22","unstructured":"Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey: 2013\u20132014 data documentation, codebook, and frequencies. https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/search\/datapage.aspx?Component=Laboratory&CycleBeginYear=2013"},{"issue":"8 Pt 2","key":"2144_CR23","doi-asserted-by":"publisher","first-page":"757","DOI":"10.7326\/0003-4819-127-8_Part_2-199710151-00064","volume":"127","author":"DB Rubin","year":"1997","unstructured":"Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 1997;127(8 Pt 2):757\u201363.","journal-title":"Ann Intern Med"},{"key":"2144_CR24","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1093\/biomet\/70.1.41","volume":"70","author":"PR Rosenbaum","year":"1983","unstructured":"Rosenbaum PR, Rubin DN. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70:41\u201355.","journal-title":"Biometrika"},{"issue":"5","key":"2144_CR25","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.1016\/j.jtcvs.2007.07.021","volume":"134","author":"PC Austin","year":"2007","unstructured":"Austin PC. Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: a systematic review and suggestions for improvement. J Thoracic Cardiovasc Surg. 2007;134(5):1128\u201335.","journal-title":"J Thoracic Cardiovasc Surg"},{"key":"2144_CR26","unstructured":"Parsons LS, Ovation Research Group. Reducing bias in a propensity score matched-pair sample using greedy matching techniques [abstract]. Presented at the Twenty-Sixth Annual SAS Users Group International conference. Cary, NC: SAS Institute, Inc.; 2001: 214\u2013226."},{"issue":"9","key":"2144_CR27","doi-asserted-by":"publisher","first-page":"603","DOI":"10.2217\/cer-2020-0013","volume":"9","author":"V Allan","year":"2020","unstructured":"Allan V, Ramagopalan SV, Mardekian J, Jenkins A, Li X, Pan X, Luo X. Propensity score matching and inverse probability of treatment weighting to address confounding by indication in comparative effectiveness research of oral anticoagulants. J Comp Eff Res. 2020;9(9):603\u201314.","journal-title":"J Comp Eff Res"},{"issue":"7","key":"2144_CR28","doi-asserted-by":"publisher","first-page":"1911","DOI":"10.1210\/jc.2011-0385","volume":"96","author":"MF Holick","year":"2011","unstructured":"Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911\u201330.","journal-title":"J Clin Endocrinol Metab"},{"key":"2144_CR29","doi-asserted-by":"publisher","first-page":"e04547","DOI":"10.2903\/j.efsa.2016.4547","volume":"14","author":"EFSA Panel on Dietetic Products Nutrition and Allergies (NDA)","year":"2016","unstructured":"EFSA Panel on Dietetic Products Nutrition and Allergies (NDA). Dietary reference values for vitamin D. EFSA J. 2016;14:e04547.","journal-title":"EFSA J"},{"issue":"6","key":"2144_CR30","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1097\/MPG.0b013e31828f3c05","volume":"56","author":"C Braegger","year":"2013","unstructured":"Braegger C, Campoy C, Colomb V, Decsi T, Domellof M, Fewtrell M, Hojsak I, Mihatsch W, Molgaard C, Shamir R, Turck D, van Goudoever J, ESPGHAN Committee on Nutrition. Vitamin D in the healthy European pediatric population. J Pediatr Gastroenterol Nutr. 2013;56(6):692\u2013701.","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"53","key":"2144_CR31","doi-asserted-by":"publisher","first-page":"101654","DOI":"10.1016\/j.eclinm.2022.101654","volume":"17","author":"K McCarthy","year":"2022","unstructured":"McCarthy K, Laird E, O\u2019Halloran AM, Walsh C, Healy M, Fitzpatrick AL, Walsh JB, Hern\u00e1ndez B, Fallon P, Molloy AM, Kenny RA. Association between vitamin D deficiency and the risk of prevalent type 2 diabetes and incident prediabetes: a prospective cohort study using data from The Irish Longitudinal Study on Ageing (TILDA). EClinicalMedicine. 2022Sep;17(53):101654.","journal-title":"EClinicalMedicine"},{"issue":"4","key":"2144_CR32","doi-asserted-by":"publisher","first-page":"1647","DOI":"10.1210\/jc.2015-4013","volume":"101","author":"R Jorde","year":"2016","unstructured":"Jorde R, Sollid ST, Svartberg J, Schirmer H, Joakimsen RM, Nj\u00f8lstad I, Fuskev\u00e5g OM, Figenschau Y, Hutchinson MY. Vitamin D 20,000 IU per week for five years does not prevent progression from prediabetes to diabetes. J Clin Endocrinol Metab. 2016;101(4):1647\u201355.","journal-title":"J Clin Endocrinol Metab"},{"issue":"377","key":"2144_CR33","doi-asserted-by":"publisher","first-page":"e066222","DOI":"10.1136\/bmj-2021-066222","volume":"25","author":"T Kawahara","year":"2022","unstructured":"Kawahara T, Suzuki G, Mizuno S, Inazu T, Kasagi F, Kawahara C, Okada Y, Tanaka Y. Effect of active vitamin D treatment on development of type 2 diabetes: DPVD randomized controlled trial in a Japanese population. BMJ. 2022May;25(377):e066222.","journal-title":"BMJ"},{"key":"2144_CR34","unstructured":"Office of Minority Health: Obesity and African Americans\u2008[article online]. Available from http:\/\/minorityhealth.hhs.gov\/templates\/content.aspx?ID=6456. Accessed 20 November 2010."},{"key":"2144_CR35","unstructured":"U.S. Census Bureau: Income, poverty, and health insurance coverage in the United States, 2009\u2008[article online]. Available from http:\/\/www.census.gov\/prod\/2010pubs\/p60-238.pdf. Accessed 20 November 2010"},{"key":"2144_CR36","first-page":"1","volume":"288","author":"CM Hales","year":"2017","unstructured":"Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015\u20132016. NCHS Data Brief. 2017;288:1\u20138.","journal-title":"NCHS Data Brief"},{"issue":"3","key":"2144_CR37","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1093\/ajcn\/72.3.690","volume":"72","author":"J Wortsman","year":"2000","unstructured":"Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72(3):690\u20133.","journal-title":"Am J Clin Nutr"},{"key":"2144_CR38","doi-asserted-by":"crossref","unstructured":"Powe CE, Evans MK, Wenger J, Zonderman AB, Berg AH, Nalls M, Tamez H, Zhang D, Bhan I, SA, Karumanchi, NR, Powe, R, Thadhani. Vitamin D-binding protein and vitamin D status of black Americans and white Americans. N Engl J Med. 2013;369(21):1991\u20132000.","DOI":"10.1056\/NEJMoa1306357"},{"issue":"6","key":"2144_CR39","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1016\/j.jclinepi.2004.10.016","volume":"58","author":"BR Shah","year":"2005","unstructured":"Shah BR, Laupacis A, Hux JE, Austin PC. Propensity score methods gave similar results to traditional regression modeling in observational studies: a systematic review. J Clin Epidemiol. 2005;58(6):550\u20139.","journal-title":"J Clin Epidemiol"}],"container-title":["Journal of Racial and Ethnic Health Disparities"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40615-024-02144-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40615-024-02144-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40615-024-02144-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T13:56:43Z","timestamp":1758203803000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40615-024-02144-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,23]]},"references-count":39,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["2144"],"URL":"https:\/\/doi.org\/10.1007\/s40615-024-02144-4","relation":{},"ISSN":["2197-3792","2196-8837"],"issn-type":[{"value":"2197-3792","type":"print"},{"value":"2196-8837","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,23]]},"assertion":[{"value":"22 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 August 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 August 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 September 2024","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study is based on publicly available data, NHANES.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"Not applicable. This happened at the data collection stage by CDC, NCHS.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}