{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T05:55:47Z","timestamp":1761630947972,"version":"3.37.3"},"reference-count":44,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T00:00:00Z","timestamp":1618358400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T00:00:00Z","timestamp":1618358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Understanding patient accumulation of comorbidities can facilitate healthcare strategy and personalized preventative care. We applied a directed network graph to electronic health record (EHR) data and characterized comorbidities in a cohort of healthy veterans undergoing screening colonoscopy. The Veterans Affairs Cooperative Studies Program #380 was a prospective longitudinal study of screening and surveillance colonoscopy. We identified initial instances of three-digit ICD-9 diagnoses for participants with at least 5\u00a0years of linked EHR history (October 1999 to December 2015). For diagnoses affecting at least 10% of patients, we calculated pairwise chronological relative risk (RR). iGraph was used to produce directed graphs of comorbidities with RR\u2009&gt;\u20091, as well as summary statistics, key diseases, and communities. A directed graph based on 2210 patients visualized longitudinal development of comorbidities. Top hub (preceding) diseases included ischemic heart disease, inflammatory and toxic neuropathy, and diabetes. Top authority (subsequent) diagnoses were acute kidney failure and hypertensive chronic kidney failure. Four communities of correlated comorbidities were identified. Close analysis of top hub and authority diagnoses demonstrated known relationships, correlated sequelae, and novel hypotheses. Directed network graphs portray chronologic comorbidity relationships. We identified relationships between comorbid diagnoses in this aging veteran cohort. This may direct healthcare prioritization and personalized care.<\/jats:p>","DOI":"10.1038\/s41598-021-85546-2","type":"journal-article","created":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T10:05:44Z","timestamp":1618394744000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Characterizing chronological accumulation of comorbidities in healthy veterans: a computational approach"],"prefix":"10.1038","volume":"11","author":[{"given":"Julian C.","family":"Hong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth R.","family":"Hauser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"IV","given":"Thomas S.","family":"Redding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kellie J.","family":"Sims","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziad F.","family":"Gellad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghan C.","family":"O\u2019Leary","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terry","family":"Hyslop","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashton N.","family":"Madison","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuejun","family":"Qin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. Jasmine","family":"Bullard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina D.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian A.","family":"Sullivan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Lieberman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawn","family":"Provenzale","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,4,14]]},"reference":[{"key":"85546_CR1","doi-asserted-by":"publisher","first-page":"E623","DOI":"10.9778\/cmajo.20170052","volume":"5","author":"M Tonelli","year":"2017","unstructured":"Tonelli, M. et al. Multimorbidity, dementia and health care in older people:a population-based cohort study. CMAJ Open 5, E623\u2013E631 (2017).","journal-title":"CMAJ Open"},{"key":"85546_CR2","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1007\/s11136-005-8661-z","volume":"15","author":"M Fortin","year":"2006","unstructured":"Fortin, M. et al. Relationship between multimorbidity and health-related Quality of Life of patients in primary care. Qual. Life Res. 15, 83\u201391 (2006).","journal-title":"Qual. Life Res."},{"key":"85546_CR3","doi-asserted-by":"publisher","DOI":"10.3233\/SHTI190087","author":"SE Kyong","year":"2019","unstructured":"Kyong, S. E. & Arash, S.-N. Applied network science for relational chronic disease surveillance. Stud. Health Technol. Inform. https:\/\/doi.org\/10.3233\/SHTI190087 (2019).","journal-title":"Stud. Health Technol. Inform."},{"key":"85546_CR4","doi-asserted-by":"publisher","first-page":"e1000353","DOI":"10.1371\/journal.pcbi.1000353","volume":"5","author":"CA Hidalgo","year":"2009","unstructured":"Hidalgo, C. A., Blumm, N., Barab\u00e1si, A.-L. & Christakis, N. A. A dynamic network approach for the study of human phenotypes. PLoS Comput. Biol. 5, e1000353 (2009).","journal-title":"PLoS Comput. Biol."},{"key":"85546_CR5","doi-asserted-by":"publisher","DOI":"10.1200\/CCI.16.00071","author":"CW Duarte","year":"2017","unstructured":"Duarte, C. W., Lindner, V. & Francis, S. A. Visualization of cancer and cardiovascular disease co-occurrence with network methods. JCO Clin. Cancer Inform. https:\/\/doi.org\/10.1200\/CCI.16.00071 (2017).","journal-title":"JCO Clin. Cancer Inform."},{"key":"85546_CR6","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.jbi.2016.03.023","volume":"61","author":"WBP Pettey","year":"2016","unstructured":"Pettey, W. B. P. et al. Using network projections to explore co-incidence and context in large clinical datasets: application to homelessness among U.S. Veterans. J. Biomed. Inform. 61, 203\u2013213 (2016).","journal-title":"J. Biomed. Inform."},{"key":"85546_CR7","doi-asserted-by":"publisher","first-page":"15608","DOI":"10.1038\/s41598-017-15753-3","volume":"7","author":"JF Valenzuela","year":"2017","unstructured":"Valenzuela, J. F., Monterola, C., Tong, V. J. C., Ng, T. P. & Larbi, A. Health and disease phenotyping in old age using a cluster network analysis. Sci. Rep. 7, 15608 (2017).","journal-title":"Sci. Rep."},{"key":"85546_CR8","doi-asserted-by":"publisher","first-page":"4557","DOI":"10.1038\/s41598-018-21779-y","volume":"8","author":"Y Jiang","year":"2018","unstructured":"Jiang, Y., Ma, S., Shia, B.-C. & Lee, T.-S. an epidemiological human disease network derived from disease co-occurrence in Taiwan. Sci. Rep. 8, 4557 (2018).","journal-title":"Sci. Rep."},{"key":"85546_CR9","doi-asserted-by":"publisher","first-page":"e22670","DOI":"10.1371\/journal.pone.0022670","volume":"6","author":"DA Davis","year":"2011","unstructured":"Davis, D. A. & Chawla, N. V. Exploring and exploiting disease interactions from multi-relational gene and phenotype networks. PLoS ONE 6, e22670 (2011).","journal-title":"PLoS ONE"},{"key":"85546_CR10","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291719002034","author":"A Lazarov","year":"2019","unstructured":"Lazarov, A. et al. Symptom structure of PTSD and co-morbid depressive symptoms\u2014a network analysis of combat veteran patients. Psychol. Med. https:\/\/doi.org\/10.1017\/S0033291719002034 (2019).","journal-title":"Psychol. Med."},{"key":"85546_CR11","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.jbi.2018.09.016","volume":"87","author":"M Kim","year":"2018","unstructured":"Kim, M. et al. Association networks in a matched case-control design\u2014co-occurrence patterns of preexisting chronic medical conditions in patients with major depression versus their matched controls. J. Biomed. Inform. 87, 88\u201395 (2018).","journal-title":"J. Biomed. Inform."},{"key":"85546_CR12","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1093\/jamia\/ocx052","volume":"25","author":"JC Brunson","year":"2018","unstructured":"Brunson, J. C. & Laubenbacher, R. C. Applications of network analysis to routinely collected health care data: a systematic review. J. Am. Med. Inform. Assoc. 25, 210\u2013221 (2018).","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"85546_CR13","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1186\/1471-2318-13-120","volume":"13","author":"H-J Dong","year":"2013","unstructured":"Dong, H.-J., Wressle, E. & Marcusson, J. Multimorbidity patterns of and use of health services by Swedish 85-year-olds: an exploratory study. BMC Geriatr. 13, 120 (2013).","journal-title":"BMC Geriatr."},{"key":"85546_CR14","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1097\/MLR.0000000000000059","volume":"52","author":"MJV Pugh","year":"2014","unstructured":"Pugh, M. J. V. et al. Complex comorbidity clusters in OEF\/OIF veterans: The polytrauma clinical triad and beyond. Med. Care 52, 172\u2013181 (2014).","journal-title":"Med. Care"},{"key":"85546_CR15","doi-asserted-by":"publisher","first-page":"e018986","DOI":"10.1136\/bmjopen-2017-018986","volume":"8","author":"A Roso-Llorach","year":"2018","unstructured":"Roso-Llorach, A. et al. Comparative analysis of methods for identifying multimorbidity patterns: a study of \u2018real-world\u2019 data. BMJ Open 8, e018986 (2018).","journal-title":"BMJ Open"},{"key":"85546_CR16","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1136\/amiajnl-2012-001117","volume":"20","author":"DA Hanauer","year":"2013","unstructured":"Hanauer, D. A. & Ramakrishnan, N. Modeling temporal relationships in large scale clinical associations. J. Am. Med. Inform. Assoc. 20, 332\u2013341 (2013).","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"85546_CR17","doi-asserted-by":"publisher","first-page":"15561","DOI":"10.1038\/s41598-017-15647-4","volume":"7","author":"E Jeong","year":"2017","unstructured":"Jeong, E., Ko, K., Oh, S. & Han, H. W. Network-based analysis of diagnosis progression patterns using claims data. Sci. Rep. 7, 15561 (2017).","journal-title":"Sci. Rep."},{"key":"85546_CR18","doi-asserted-by":"publisher","first-page":"4022","DOI":"10.1038\/ncomms5022","volume":"5","author":"AB Jensen","year":"2014","unstructured":"Jensen, A. B. et al. Temporal disease trajectories condensed from population-wide registry data covering 6.2 million patients. Nat. Commun. 5, 4022 (2014).","journal-title":"Nat. Commun."},{"key":"85546_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41597-019-0220-5","volume":"6","author":"H Paik","year":"2019","unstructured":"Paik, H. et al. Tracing diagnosis trajectories over millions of patients reveal an unexpected risk in schizophrenia. Sci. Data 6, 1\u201310 (2019).","journal-title":"Sci. Data"},{"key":"85546_CR20","doi-asserted-by":"publisher","first-page":"e000302","DOI":"10.1136\/bmjresp-2018-000302","volume":"5","author":"\u00c1 T\u00e9nyi","year":"2018","unstructured":"T\u00e9nyi, \u00c1. et al. Risk and temporal order of disease diagnosis of comorbidities in patients with COPD: a population health perspective. BMJ Open Respir. Res. 5, e000302 (2018).","journal-title":"BMJ Open Respir. Res."},{"key":"85546_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ijmedinf.2018.04.001","volume":"115","author":"A Khan","year":"2018","unstructured":"Khan, A., Uddin, S. & Srinivasan, U. Comorbidity network for chronic disease: a novel approach to understand type 2 diabetes progression. Int. J. Med. Inf. 115, 1\u20139 (2018).","journal-title":"Int. J. Med. Inf."},{"key":"85546_CR22","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1007\/s41109-018-0106-z","volume":"3","author":"PB Thomas","year":"2018","unstructured":"Thomas, P. B., Robertson, D. H. & Chawla, N. V. Predicting onset of complications from diabetes: a graph based approach. Appl. Netw. Sci. 3, 48 (2018).","journal-title":"Appl. Netw. Sci."},{"key":"85546_CR23","doi-asserted-by":"publisher","first-page":"i101","DOI":"10.1093\/bioinformatics\/btw282","volume":"32","author":"BS Glicksberg","year":"2016","unstructured":"Glicksberg, B. S. et al. Comparative analyses of population-scale phenomic data in electronic medical records reveal race-specific disease networks. Bioinform. Oxf. Engl. 32, i101\u2013i110 (2016).","journal-title":"Bioinform. Oxf. Engl."},{"key":"85546_CR24","doi-asserted-by":"publisher","first-page":"26170","DOI":"10.1038\/srep26170","volume":"6","author":"V Kannan","year":"2016","unstructured":"Kannan, V. et al. conditional disease development extracted from longitudinal health care cohort data using layered network construction. Sci. Rep. 6, 26170 (2016).","journal-title":"Sci. Rep."},{"key":"85546_CR25","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1056\/NEJM200007203430301","volume":"343","author":"DA Lieberman","year":"2000","unstructured":"Lieberman, D. A. et al. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N. Engl. J. Med. 343, 162\u2013168 (2000).","journal-title":"N. Engl. J. Med."},{"key":"85546_CR26","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1053\/j.gastro.2007.07.006","volume":"133","author":"DA Lieberman","year":"2007","unstructured":"Lieberman, D. A. et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology 133, 1077\u20131085 (2007).","journal-title":"Gastroenterology"},{"key":"85546_CR27","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1093\/gerona\/glv202","volume":"71","author":"HE Whitson","year":"2016","unstructured":"Whitson, H. E. et al. Physical resilience in older adults: systematic review and development of an emerging construct. J. Gerontol. A. Biol. Sci. Med. Sci. 71, 489\u2013495 (2016).","journal-title":"J. Gerontol. A. Biol. Sci. Med. Sci."},{"key":"85546_CR28","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glz097","author":"C Col\u00f3n-Emeric","year":"2019","unstructured":"Col\u00f3n-Emeric, C. et al. Two approaches to classifying and quantifying physical resilience in longitudinal data. J. Gerontol. A. Biol. Sci. Med. Sci. https:\/\/doi.org\/10.1093\/gerona\/glz097 (2019).","journal-title":"J. Gerontol. A. Biol. Sci. Med. Sci."},{"key":"85546_CR29","doi-asserted-by":"publisher","first-page":"2038","DOI":"10.1186\/s12882-017-0541-6","volume":"18","author":"CA Peralta","year":"2017","unstructured":"Peralta, C. A. et al. Implementation of a pragmatic randomized trial of screening for chronic kidney disease to improve care among non-diabetic hypertensive veterans. BMC Nephrol. 18, 2038 (2017).","journal-title":"BMC Nephrol."},{"key":"85546_CR30","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1097\/MNH.0000000000000223","volume":"25","author":"HM Szerlip","year":"2016","unstructured":"Szerlip, H. M. & Chawla, L. S. Predicting acute kidney injury prognosis. Curr. Opin. Nephrol. Hypertens. 25, 226\u2013231 (2016).","journal-title":"Curr. Opin. Nephrol. Hypertens."},{"key":"85546_CR31","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1001\/jamainternmed.2018.0411","volume":"178","author":"M Kurella Tamura","year":"2018","unstructured":"Kurella Tamura, M. et al. Dialysis initiation and mortality among older veterans with kidney failure treated in medicare vs the department of veterans affairs. JAMA Intern. Med. 178, 657\u2013664 (2018).","journal-title":"JAMA Intern. Med."},{"key":"85546_CR32","doi-asserted-by":"publisher","first-page":"e027439","DOI":"10.1136\/bmjopen-2018-027439","volume":"9","author":"N Elkhadragy","year":"2019","unstructured":"Elkhadragy, N. et al. Medication decision-making for patients with renal insufficiency in inpatient and outpatient care at a US Veterans Affairs Medical Centre: a qualitative, cognitive task analysis. BMJ Open 9, e027439 (2019).","journal-title":"BMJ Open"},{"key":"85546_CR33","doi-asserted-by":"publisher","first-page":"30750","DOI":"10.1038\/srep30750","volume":"6","author":"Z Yang","year":"2016","unstructured":"Yang, Z., Algesheimer, R. & Tessone, C. J. A comparative analysis of community detection algorithms on artificial networks. Sci. Rep. 6, 30750 (2016).","journal-title":"Sci. Rep."},{"key":"85546_CR34","doi-asserted-by":"publisher","first-page":"109744","DOI":"10.1016\/j.jpsychores.2019.109744","volume":"124","author":"B Nichter","year":"2019","unstructured":"Nichter, B., Norman, S., Haller, M. & Pietrzak, R. H. Physical health burden of PTSD, depression, and their comorbidity in the U.S. veteran population: Morbidity, functioning, and disability. J. Psychosom. Res. 124, 109744 (2019).","journal-title":"J. Psychosom. Res."},{"key":"85546_CR35","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16126","author":"RT Morin","year":"2019","unstructured":"Morin, R. T. et al. Comorbidity profiles identified in older primary care patients who attempt suicide. J. Am. Geriatr. Soc. https:\/\/doi.org\/10.1111\/jgs.16126 (2019).","journal-title":"J. Am. Geriatr. Soc."},{"key":"85546_CR36","doi-asserted-by":"publisher","DOI":"10.1080\/08964289.2019.1644283","author":"SK Creech","year":"2019","unstructured":"Creech, S. K. et al. Clinical complexity in women veterans: a systematic review of the recent evidence on mental health and physical health comorbidities. Behav. Med. https:\/\/doi.org\/10.1080\/08964289.2019.1644283 (2019).","journal-title":"Behav. Med."},{"key":"85546_CR37","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.07.052","author":"D Lieberman","year":"2019","unstructured":"Lieberman, D. et al. Baseline colonoscopy findings associated with 10-year outcomes in a screening cohort undergoing colonoscopy surveillance. Gastroenterology https:\/\/doi.org\/10.1053\/j.gastro.2019.07.052 (2019).","journal-title":"Gastroenterology"},{"key":"85546_CR38","unstructured":"Wasey, J. Package \u2018icd\u2019. https:\/\/cran.r-project.org\/web\/packages\/icd\/icd.pdf (2017)."},{"key":"85546_CR39","unstructured":"Csardi, G. & Nepusz, T. The igraph software package for complex network research. InterJournal (2006)."},{"key":"85546_CR40","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1145\/324133.324140","volume":"46","author":"JM Kleinberg","year":"1999","unstructured":"Kleinberg, J. M. Authoritative sources in a hyperlinked environment. J. ACM 46, 604\u2013632 (1999).","journal-title":"J. ACM"},{"key":"85546_CR41","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/S0169-7552(98)00110-X","volume":"30","author":"S Brin","year":"1998","unstructured":"Brin, S. & Page, L. The anatomy of a large-scale hypertextual web search engine. Comput. Netw. ISDN Syst. 30, 107\u2013117 (1998).","journal-title":"Comput. Netw. ISDN Syst."},{"key":"85546_CR42","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1073\/pnas.0706851105","volume":"105","author":"M Rosvall","year":"2008","unstructured":"Rosvall, M. & Bergstrom, C. T. Maps of random walks on complex networks reveal community structure. Proc. Natl. Acad. Sci. USA 105, 1118\u20131123 (2008).","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"85546_CR43","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1140\/epjst\/e2010-01179-1","volume":"178","author":"M Rosvall","year":"2009","unstructured":"Rosvall, M., Axelsson, D. & Bergstrom, C. T. The map equation. Eur. Phys. J. Spec. Top. 178, 13\u201323 (2009).","journal-title":"Eur. Phys. J. Spec. Top."},{"key":"85546_CR44","unstructured":"Bohlin, L., Edler, D., Lancichinetti, A. & Rosvall, M. Community detection and visualization of networks with the map equation framework. Map Equation https:\/\/www.mapequation.org\/assets\/publications\/mapequationtutorial.pdf."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-85546-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-85546-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-85546-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T06:35:44Z","timestamp":1670049344000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-85546-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,14]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["85546"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-85546-2","relation":{},"ISSN":["2045-2322"],"issn-type":[{"type":"electronic","value":"2045-2322"}],"subject":[],"published":{"date-parts":[[2021,4,14]]},"assertion":[{"value":"13 March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 December 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Julian Hong is an inventor on a pending patent, \u201cSystems and methods for predicting acute care visits during outpatient cancer therapy,\u201d not related to this manuscript. David Lieberman serves on the scientific advisory boards for Freenome, Check-Cap Ltd., and Cambridge Epigenetix. All other authors have no potential conflicts to disclose.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"8104"}}