{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:20:26Z","timestamp":1791822026078,"version":"4.3.4"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T00:00:00Z","timestamp":1575590400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T00:00:00Z","timestamp":1575590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000002","name":"U.S. Department of Health & Human Services | National Institutes of Health","doi-asserted-by":"publisher","award":["P30AG043073"],"award-info":[{"award-number":["P30AG043073"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"U.S. Department of Health & Human Services | National Institutes of Health","doi-asserted-by":"publisher","award":["P30AG024968"],"award-info":[{"award-number":["P30AG024968"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"U.S. Department of Health & Human Services | National Institutes of Health","doi-asserted-by":"publisher","award":["P30AG043073"],"award-info":[{"award-number":["P30AG043073"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"U.S. Department of Health & Human Services | National Institutes of Health"},{"name":"U.S. Department of Health & Human Services | National Institutes of Health"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>People living with HIV\/AIDS (PLWHA) have a growing life expectancy in the US due to early provision of effective antiretroviral treatment. This has resulted in increasing exposure to age-related chronic illness that may be exacerbated by HIV\/AIDS or antiretroviral treatment. Prior work has suggested that PLWHA may be subject to accelerated aging, with earlier onset and higher risk of acquiring many chronic illnesses. However, the magnitude of these effects, controlling for chronic co-morbidities, has not been fully quantified. We evaluate the magnitude of association of HIV infection on developing chronic conditions while controlling for demographics, behavioral risk factors, and chronic comorbidities. We compare chronic disease risks of diabetes, hypertension, stroke, cancers, lung diseases, cardiovascular diseases, and cognitive impairment between PLWHA and HIV- individuals in a large, de-identified private insurance claims dataset (~24,000 PLWHA) using logistic regressions. HIV status is statistically significantly associated with higher levels for all chronic illnesses examined, a result which is robust to multiple model specifications and duration of analysis (2, 5, and 10 years from enrollment). Our results suggest that PLWHA may be at elevated risk for a wide variety of chronic illnesses and may require additional care as the aging PLWHA population grows.<\/jats:p>","DOI":"10.1038\/s41598-019-54969-3","type":"journal-article","created":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T11:02:54Z","timestamp":1575630174000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":81,"title":["Chronic Disease Onset Among People Living with HIV and AIDS in a Large Private Insurance Claims Dataset"],"prefix":"10.1038","volume":"9","author":[{"given":"Hsin-Yun","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew R.","family":"Beymer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9453-5863","authenticated-orcid":false,"given":"Sze-chuan","family":"Suen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,12,6]]},"reference":[{"key":"54969_CR1","unstructured":"Antiretroviral Therapy Cohort Collaboration (ART-CC). Survival of HIV-positive Patients Starting Antiretroviral Therapy Between 1996 and 2013: A Collaborative Analysis of Cohort Studies. Lancet HIV 3018 (2017)."},{"issue":"1","key":"54969_CR2","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/QAI.0000000000001014","volume":"73","author":"Julia L. Marcus","year":"2016","unstructured":"Marcus, J. L. et al. Narrowing the Gap in Life Expectancy between HIV-Infected and HIV-Uninfected Individuals with Access to Care. In Journal of Acquired Immune Deficiency Syndromes, https:\/\/doi.org\/10.1097\/QAI.0000000000001014 (2016).","journal-title":"JAIDS Journal of Acquired Immune Deficiency Syndromes"},{"key":"54969_CR3","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1097\/QAD.0000000000000243","volume":"28","author":"MT May","year":"2014","unstructured":"May, M. T. et al. Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy. AIDS 28, 1193\u2013202 (2014).","journal-title":"AIDS"},{"key":"54969_CR4","unstructured":"Centers for Disease Control and Prevention. HIV Among People Aged 50 and Over (2017)."},{"key":"54969_CR5","unstructured":"Centers for Disease Control and Prevention. HIV Among People Aged 50 and Older. Available at: https:\/\/www.cdc.gov\/hiv\/group\/age\/olderamericans\/index.html (2018)."},{"issue":"2","key":"54969_CR6","doi-asserted-by":"publisher","first-page":"e193","DOI":"10.1016\/S2214-109X(17)30451-5","volume":"6","author":"Jean Joel Bigna","year":"2018","unstructured":"Bigna, J. J., Kenne, A. M., Asangbeh, S. L. & Sibetcheu, A. T. Prevalence of chronic obstructive pulmonary disease in the global population with HIV: a systematic review and meta-analysis. Lancet Glob. Heal., https:\/\/doi.org\/10.1016\/S2214-109X(17)30451-5 (2018).","journal-title":"The Lancet Global Health"},{"key":"54969_CR7","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1093\/cid\/ciy146","volume":"67","author":"M Gelpi","year":"2018","unstructured":"Gelpi, M. et al. Higher Risk of Abdominal Obesity, Elevated Low-Density Lipoprotein Cholesterol, and Hypertriglyceridemia, but not of Hypertension, in People Living With Human Immunodeficiency Virus (HIV): Results From the Copenhagen Comorbidity in HIV Infection Study. Clin. Infect. Dis. 67, 579\u2013586 (2018).","journal-title":"Clin. Infect. Dis."},{"issue":"1","key":"54969_CR8","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1177\/0033354917748670","volume":"133","author":"Kenneth H. Mayer","year":"2017","unstructured":"Mayer, K. H. et al. Excess clinical comorbidity among HIV-infected patients accessing primary care in US community health centers. Public Health Rep., https:\/\/doi.org\/10.1177\/0033354917748670 (2018).","journal-title":"Public Health Reports"},{"key":"54969_CR9","doi-asserted-by":"publisher","first-page":"2529","DOI":"10.1097\/QAD.0000000000001215","volume":"30","author":"EE Friedman","year":"2016","unstructured":"Friedman, E. E. & Duffus, W. A. Chronic health conditions in Medicare beneficiaries 65 years old, and older with HIV infection. AIDS 30, 2529\u20132536 (2016).","journal-title":"AIDS"},{"key":"54969_CR10","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1093\/cid\/ciu701","volume":"59","author":"J Schouten","year":"2014","unstructured":"Schouten, J. et al. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. Clin. Infect. Dis. 59, 1787\u201397 (2014).","journal-title":"Clin. Infect. Dis."},{"key":"54969_CR11","first-page":"e13","volume":"24","author":"SM Grundy","year":"2004","unstructured":"Grundy, S. M. et al. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute\/American Heart Association conference on scientific issues related to definition. Arterioscler. Thromb. Vasc. Biol. 24, e13\u20138 (2004).","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"54969_CR12","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1016\/j.amjmed.2006.02.031","volume":"119","author":"A Galassi","year":"2006","unstructured":"Galassi, A., Reynolds, K. & He, J. Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. Am. J. Med. 119, 812\u20139 (2006).","journal-title":"Am. J. Med."},{"key":"54969_CR13","doi-asserted-by":"publisher","first-page":"3066","DOI":"10.1161\/CIRCULATIONAHA.105.539528","volume":"112","author":"PWF Wilson","year":"2005","unstructured":"Wilson, P. W. F., D\u2019Agostino, R. B., Parise, H., Sullivan, L. & Meigs, J. B. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation 112, 3066\u201372 (2005).","journal-title":"Circulation"},{"key":"54969_CR14","doi-asserted-by":"crossref","unstructured":"Barbaro, G. & Iacobellis, G. Metabolic syndrome associated with HIV and highly active antiretroviral therapy. Curr. Diab. Rep. (2009).","DOI":"10.1007\/s11892-009-0008-7"},{"key":"54969_CR15","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1177\/0956462417732226","volume":"29","author":"J Echecopar-Sabogal","year":"2018","unstructured":"Echecopar-Sabogal, J., D\u2019Angelo-Piaggio, L., Chanam\u00e9-Baca, D. M. & Ugarte-Gil, C. Association between the use of protease inhibitors in highly active antiretroviral therapy and incidence of diabetes mellitus and\/or metabolic syndrome in HIV-infected patients: A systematic review and meta-analysis. Int. J. STD AIDS 29, 443\u2013452 (2018).","journal-title":"Int. J. STD AIDS"},{"issue":"1","key":"54969_CR16","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/1742-6405-10-32","volume":"10","author":"Adelzon A Paula","year":"2013","unstructured":"Paula, A. A., Falc\u00e3o, M. C. N. & Pacheco, A. G. Metabolic syndrome in HIV-infected individuals: Underlying mechanisms and epidemiological aspects. AIDS Research and Therapy, https:\/\/doi.org\/10.1186\/1742-6405-10-32 (2013).","journal-title":"AIDS Research and Therapy"},{"key":"54969_CR17","first-page":"201027","volume":"2012","author":"JPH van Wijk","year":"2012","unstructured":"van Wijk, J. P. H. & Cabezas, M. C. Hypertriglyceridemia, Metabolic Syndrome, and Cardiovascular Disease in HIV-Infected Patients: Effects of Antiretroviral Therapy and Adipose Tissue Distribution. Int. J. Vasc. Med. 2012, 201027 (2012).","journal-title":"Int. J. Vasc. Med."},{"key":"54969_CR18","doi-asserted-by":"publisher","first-page":"2445","DOI":"10.1097\/QAD.0b013e3282efad32","volume":"21","author":"H Wand","year":"2007","unstructured":"Wand, H. et al. Metabolic syndrome, cardiovascular disease and type 2 diabetes mellitus after initiation of antiretroviral therapy in HIV infection. AIDS 21, 2445\u201353 (2007).","journal-title":"AIDS"},{"key":"54969_CR19","doi-asserted-by":"publisher","first-page":"103063","DOI":"10.1155\/2012\/103063","volume":"2012","author":"J Palios","year":"2012","unstructured":"Palios, J., Kadoglou, N. P. E. & Lampropoulos, S. The pathophysiology of HIV-\/HAART-related metabolic syndrome leading to cardiovascular disorders: the emerging role of adipokines. Exp. Diabetes Res. 2012, 103063 (2012).","journal-title":"Exp. Diabetes Res."},{"key":"54969_CR20","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1016\/j.immuni.2013.10.001","volume":"39","author":"SG Deeks","year":"2013","unstructured":"Deeks, S. G., Tracy, R. & Douek, D. C. Systemic effects of inflammation on health during chronic HIV infection. Immunity 39, 633\u201345 (2013).","journal-title":"Immunity"},{"issue":"5","key":"54969_CR21","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1080\/13854046.2015.1077995","volume":"29","author":"David P. Sheppard","year":"2015","unstructured":"Sheppard, D. P. et al. Does Older Age Confer an Increased Risk of Incident Neurocognitive Disorders among Persons Living with HIV Disease? Clin. Neuropsychol., https:\/\/doi.org\/10.1080\/13854046.2015.1077995 (2015).","journal-title":"The Clinical Neuropsychologist"},{"key":"54969_CR22","doi-asserted-by":"publisher","first-page":"2244","DOI":"10.2337\/dc10-0633","volume":"33","author":"TT Brown","year":"2010","unstructured":"Brown, T. T., Tassiopoulos, K., Bosch, R. J., Shikuma, C. & McComsey, G. A. Association between systemic inflammation and incident diabetes in HIV-infected patients after initiation of antiretroviral therapy. Diabetes Care 33, 2244\u20139 (2010).","journal-title":"Diabetes Care"},{"key":"54969_CR23","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1093\/jnci\/djr076","volume":"103","author":"MS Shiels","year":"2011","unstructured":"Shiels, M. S. et al. Cancer burden in the HIV-infected population in the United States. J. Natl. Cancer Inst. 103, 753\u201362 (2011).","journal-title":"J. Natl. Cancer Inst."},{"issue":"1","key":"54969_CR24","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1086\/518606","volume":"45","author":"G. D. Kirk","year":"2007","unstructured":"Kirk, G. D. et al. HIV Infection Is Associated with an Increased Risk for Lung Cancer, Independent of Smoking. Clin. Infect. Dis., https:\/\/doi.org\/10.1086\/518606 (2007).","journal-title":"Clinical Infectious Diseases"},{"key":"54969_CR25","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1212\/WNL.0b013e31820a0cfc","volume":"76","author":"B Ovbiagele","year":"2011","unstructured":"Ovbiagele, B. & Nath, A. Increasing incidence of ischemic stroke in patients with HIV infection. Neurology 76, 444\u201350 (2011).","journal-title":"Neurology"},{"key":"54969_CR26","doi-asserted-by":"publisher","first-page":"1326","DOI":"10.1378\/chest.130.5.1326","volume":"130","author":"K Crothers","year":"2006","unstructured":"Crothers, K. et al. Increased COPD among HIV-positive compared to HIV-negative veterans. Chest 130, 1326\u201333 (2006).","journal-title":"Chest"},{"issue":"5","key":"54969_CR27","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1590\/0037-8682-0258-2017","volume":"50","author":"Mariana Amaral Raposo","year":"2017","unstructured":"Raposo, M. A. et al. Metabolic disorders and cardiovascular risk in people living with HIV\/AIDS without the use of antiretroviral therapy. Rev. Soc. Bras. Med. Trop. 50, 598\u2013606 (2017).","journal-title":"Revista da Sociedade Brasileira de Medicina Tropical"},{"key":"54969_CR28","doi-asserted-by":"publisher","first-page":"1663","DOI":"10.1097\/QAD.0000000000001077","volume":"30","author":"EL Yanik","year":"2016","unstructured":"Yanik, E. L., Katki, H. A. & Engels, E. A. Cancer risk among the HIV-infected elderly in the United States. Aids 30, 1663\u20131668 (2016).","journal-title":"Aids"},{"key":"54969_CR29","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1136\/bmj.a3172","volume":"338","author":"SG Deeks","year":"2009","unstructured":"Deeks, S. G. & Phillips, A. N. HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity. BMJ 338, 288\u2013292 (2009).","journal-title":"BMJ"},{"issue":"4","key":"54969_CR30","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1002\/gps.4652","volume":"32","author":"Mark B. Snowden","year":"2017","unstructured":"Snowden, M. B. et al. Dementia and co-occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence? International Journal of Geriatric Psychiatry, https:\/\/doi.org\/10.1002\/gps.4652 (2017).","journal-title":"International Journal of Geriatric Psychiatry"},{"issue":"5","key":"54969_CR31","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/j.jamda.2017.02.010","volume":"18","author":"John E. Morley","year":"2017","unstructured":"Morley, J. E. Cognition and Chronic Disease. J. Am. Med. Dir. Assoc., https:\/\/doi.org\/10.1016\/j.jamda.2017.02.010 (2017).","journal-title":"Journal of the American Medical Directors Association"},{"key":"54969_CR32","first-page":"2015","volume":"72","author":"CMS.gov.","year":"2015","unstructured":"CMS.gov. CMS Chronic Conditions Data Warehouse (CCW) CCW Condition Algorithms. Chronic Cond. Algorithms 72, 2015 (2015).","journal-title":"Chronic Cond. Algorithms"},{"key":"54969_CR33","first-page":"121","volume":"10","author":"C Odhiambo","year":"2017","unstructured":"Odhiambo, C. & Carolina, S. Risk for Cardiovascular Disease in Blacks with HIV\/AIDS in America: A Systematic Review and Meta-analysis. J. Health Dispar. Res. Pract. 10, 121\u2013140 (2017).","journal-title":"J. Health Dispar. Res. Pract."},{"key":"54969_CR34","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1080\/09540121.2018.1434120","volume":"30","author":"DM Smith","year":"2018","unstructured":"Smith, D. M. et al. Mortality among people living with HIV\/AIDS with non-small-cell lung cancer in the modern HAART Era. AIDS Care - Psychol. Socio-Medical Asp. AIDS\/HIV 30, 936\u2013942 (2018).","journal-title":"AIDS Care - Psychol. Socio-Medical Asp. AIDS\/HIV"},{"key":"54969_CR35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2019\/8306823","volume":"2019","author":"G Yideg Yitbarek","year":"2019","unstructured":"Yideg Yitbarek, G., Mossie Ayana, A., Bariso Gare, M. & Garedew Woldeamanuel, G. Prevalence of Cognitive Impairment and Its Predictors among HIV\/AIDS Patients on Antiretroviral Therapy in Jimma University Medical Center, Southwest Ethiopia. Psychiatry J. 2019, 1\u20137 (2019).","journal-title":"Psychiatry J."},{"key":"54969_CR36","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1164\/rccm.2112096","volume":"166","author":"NR Anthonisen","year":"2002","unstructured":"Anthonisen, N. R., Connett, J. E. & Murray, R. P. Smoking and lung function of Lung Health Study participants after 11 years. Am J Respir Crit Care Med 2002, 166(5):675-9. Am J Respir Crit Care Med 166, 675\u20139 (2002).","journal-title":"Am J Respir Crit Care Med"},{"issue":"4","key":"54969_CR37","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1046\/j.1532-5415.2001.49085.x","volume":"49","author":"Vince Salazar Thomas","year":"2001","unstructured":"Thomas, V. S. & Rockwood, K. J. Alcohol abuse, cognitive impairment, and mortality among older people. J. Am. Geriatr. Soc., https:\/\/doi.org\/10.1046\/j.1532-5415.2001.49085.x (2001).","journal-title":"Journal of the American Geriatrics Society"},{"key":"54969_CR38","doi-asserted-by":"publisher","first-page":"8S","DOI":"10.1016\/0002-9343(92)90620-Q","volume":"93","author":"JB Lakier","year":"1992","unstructured":"Lakier, J. B. Smoking and Cardiovascular Disease. Am. J. Med. 93, 8S\u201312S (1992).","journal-title":"Am. J. Med."},{"issue":"4","key":"54969_CR39","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1097\/01.hdx.0000080713.09303.a6","volume":"5","author":"William H. Frishman","year":"2003","unstructured":"Frishman, W. H., Del Vecchio, A., Sanal, S. & Ismail, A. Cardiovascular manifestations of substance abuse: Part 2: Alcohol, amphetamines, heroin, cannabis, and caffeine. Heart Disease, https:\/\/doi.org\/10.1097\/01.hdx.0000080713.09303.a6 (2003).","journal-title":"Heart Disease"},{"issue":"10","key":"54969_CR40","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1089\/apc.2018.0066","volume":"32","author":"Ellen A. Almirol","year":"2018","unstructured":"Almirol, E. A. et al. Gender Differences in HIV Testing, Diagnosis, and Linkage to Care in Healthcare Settings: Identifying African American Women with HIV in Chicago. AIDS Patient Care STDS, https:\/\/doi.org\/10.1089\/apc.2018.0066 (2018).","journal-title":"AIDS Patient Care and STDs"},{"issue":"1","key":"54969_CR41","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1007\/s10461-016-1504-9","volume":"21","author":"Caroline K. Darlington","year":"2016","unstructured":"Darlington, C. K. & Hutson, S. P. Understanding HIV-Related Stigma Among Women in the Southern United States: A Literature Review. AIDS and Behavior, https:\/\/doi.org\/10.1007\/s10461-016-1504-9 (2017).","journal-title":"AIDS and Behavior"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-019-54969-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-019-54969-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-019-54969-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,17]],"date-time":"2022-12-17T17:02:38Z","timestamp":1671296558000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-019-54969-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,6]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["54969"],"URL":"https:\/\/doi.org\/10.1038\/s41598-019-54969-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,6]]},"assertion":[{"value":"24 July 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 November 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 December 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"18514"}}