{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T05:27:58Z","timestamp":1791091678687,"version":"4.1.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"Innovative Province Construction Special Science Project","award":["2023ZK4186"],"award-info":[{"award-number":["2023ZK4186"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-025-91715-4","type":"journal-article","created":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T07:44:27Z","timestamp":1740987867000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Bidirectional Mendelian randomization study reveals interplay between multisite chronic pain and Post-traumatic stress disorder"],"prefix":"10.1038","volume":"15","author":[{"given":"Zheng","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoyun","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuibing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuochao","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,3]]},"reference":[{"issue":"2","key":"91715_CR1","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1056\/NEJMra012941","volume":"346","author":"R Yehuda","year":"2002","unstructured":"Yehuda, R. Post-traumatic stress disorder. N Engl. J. Med. 346 (2), 108\u2013114. https:\/\/doi.org\/10.1056\/NEJMra012941 (2002).","journal-title":"N Engl. J. Med."},{"issue":"Suppl 5","key":"91715_CR2","first-page":"4","volume":"61","author":"RC Kessler","year":"2000","unstructured":"Kessler, R. C. Posttraumatic stress disorder: the burden to the individual and to society. J. Clin. Psychiatry. 61 (Suppl 5), 4\u201312 (2000). discussion 3\u20134. doi.","journal-title":"J. Clin. Psychiatry"},{"issue":"6","key":"91715_CR3","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1016\/j.cpr.2013.05.002","volume":"33","author":"JA DiGangi","year":"2013","unstructured":"DiGangi, J. A. et al. Pretrauma risk factors for posttraumatic stress disorder: a systematic review of the literature. Clin. Psychol. Rev. 33 (6), 728\u2013744. https:\/\/doi.org\/10.1016\/j.cpr.2013.05.002 (2013).","journal-title":"Clin. Psychol. Rev."},{"issue":"13","key":"91715_CR4","doi-asserted-by":"publisher","first-page":"2260","DOI":"10.1017\/s0033291717000708","volume":"47","author":"KC Koenen","year":"2017","unstructured":"Koenen, K. C. et al. Posttraumatic stress disorder in the world mental health surveys. Psychol. Med. 47 (13), 2260\u20132274. https:\/\/doi.org\/10.1017\/s0033291717000708 (2017).","journal-title":"Psychol. Med."},{"key":"91715_CR5","doi-asserted-by":"publisher","unstructured":"Davis, L. L. et al. The economic burden of posttraumatic stress disorder in the united States from a societal perspective. J. Clin. Psychiatry. 83 (3). https:\/\/doi.org\/10.4088\/JCP.21m14116 (2022).","DOI":"10.4088\/JCP.21m14116"},{"key":"91715_CR6","unstructured":"Merskey, H. E. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Pain doi. (1986)."},{"issue":"10289","key":"91715_CR7","doi-asserted-by":"publisher","first-page":"2082","DOI":"10.1016\/s0140-6736(21)00393-7","volume":"397","author":"SP Cohen","year":"2021","unstructured":"Cohen, S. P., Vase, L. & Hooten, W. M. Chronic pain: an update on burden, best practices, and new advances. Lancet 397 (10289), 2082\u20132097. https:\/\/doi.org\/10.1016\/s0140-6736(21)00393-7 (2021).","journal-title":"Lancet"},{"issue":"12","key":"91715_CR8","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/s11916-019-0828-3","volume":"23","author":"S Kind","year":"2019","unstructured":"Kind, S. & Otis, J. D. The interaction between chronic pain and PTSD. Curr. Pain Headache Rep. 23 (12), 91. https:\/\/doi.org\/10.1007\/s11916-019-0828-3 (2019).","journal-title":"Curr. Pain Headache Rep."},{"issue":"10","key":"91715_CR9","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1177\/070674370204701004","volume":"47","author":"GJ Asmundson","year":"2002","unstructured":"Asmundson, G. J., Coons, M. J., Taylor, S. & Katz, J. PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can. J. Psychiatry. 47 (10), 930\u2013937. https:\/\/doi.org\/10.1177\/070674370204701004 (2002).","journal-title":"Can. J. Psychiatry"},{"issue":"6","key":"91715_CR10","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1016\/s0272-7358(00)00071-4","volume":"21","author":"TJ Sharp","year":"2001","unstructured":"Sharp, T. J. & Harvey, A. G. Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin. Psychol. Rev. 21 (6), 857\u2013877. https:\/\/doi.org\/10.1016\/s0272-7358(00)00071-4 (2001).","journal-title":"Clin. Psychol. Rev."},{"issue":"4, Supplement","key":"91715_CR11","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.jpain.2024.01.032","volume":"25","author":"N Tsur","year":"2024","unstructured":"Tsur, N. The link between trauma and chronic pain: exploring the role of pain flashbacks in chronic pain following interpersonal trauma. J. Pain. 25 (4, Supplement), 6. https:\/\/doi.org\/10.1016\/j.jpain.2024.01.032 (2024).","journal-title":"J. Pain"},{"issue":"s1","key":"91715_CR12","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1017\/cts.2020.345","volume":"4","author":"J Pierce","year":"2020","unstructured":"Pierce, J., Hassett, A. L., Harris, R. E., Goesling, J. & Brummett, C. M. 4385 The pain and social experiences project: Understanding the role of interpersonal trauma in pain. J. Clin. Translational Sci. 4 (s1), 113. https:\/\/doi.org\/10.1017\/cts.2020.345 (2020).","journal-title":"J. Clin. Translational Sci."},{"issue":"4","key":"91715_CR13","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1017\/s0033291707001389","volume":"38","author":"SB Norman","year":"2008","unstructured":"Norman, S. B., Stein, M. B., Dimsdale, J. E. & Hoyt, D. B. Pain in the aftermath of trauma is a risk factor for post-traumatic stress disorder. Psychol. Med. 38 (4), 533\u2013542. https:\/\/doi.org\/10.1017\/s0033291707001389 (2008).","journal-title":"Psychol. Med."},{"key":"91715_CR14","doi-asserted-by":"publisher","first-page":"527","DOI":"10.2147\/jpr.S155241","volume":"11","author":"SL Ravn","year":"2018","unstructured":"Ravn, S. L., Vaegter, H. B., Cardel, T. & Andersen, T. E. The role of posttraumatic stress symptoms on chronic pain outcomes in chronic pain patients referred to rehabilitation. J. Pain Res. 11, 527\u2013536. https:\/\/doi.org\/10.2147\/jpr.S155241 (2018).","journal-title":"J. Pain Res."},{"key":"91715_CR15","doi-asserted-by":"publisher","first-page":"164","DOI":"10.3389\/fpsyt.2017.00164","volume":"8","author":"J Siqveland","year":"2017","unstructured":"Siqveland, J., Hussain, A., Lindstr\u00f8m, J. C., Ruud, T. & Hauff, E. Prevalence of posttraumatic stress disorder in persons with chronic pain: A Meta-analysis. Front. Psychiatry. 8, 164. https:\/\/doi.org\/10.3389\/fpsyt.2017.00164 (2017).","journal-title":"Front. Psychiatry"},{"key":"91715_CR16","doi-asserted-by":"publisher","unstructured":"Sanderson, E. et al. Mendelian randomization. Nat. Rev. Methods Primers. 2 https:\/\/doi.org\/10.1038\/s43586-021-00092-5 (2022).","DOI":"10.1038\/s43586-021-00092-5"},{"issue":"1","key":"91715_CR17","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1002\/sim.2739","volume":"26","author":"DB Rubin","year":"2007","unstructured":"Rubin, D. B. The design versus the analysis of observational studies for causal effects: parallels with the design of randomized trials. Stat. Med. 26 (1), 20\u201336. https:\/\/doi.org\/10.1002\/sim.2739 (2007).","journal-title":"Stat. Med."},{"issue":"22","key":"91715_CR18","doi-asserted-by":"publisher","first-page":"2386","DOI":"10.1001\/jama.2009.812","volume":"301","author":"G Thanassoulis","year":"2009","unstructured":"Thanassoulis, G. & O\u2019Donnell, C. J. Mendelian randomization: Nature\u2019s randomized trial in the post-genome era. Jama 301 (22), 2386\u20132388. https:\/\/doi.org\/10.1001\/jama.2009.812 (2009).","journal-title":"Jama"},{"key":"91715_CR19","doi-asserted-by":"publisher","first-page":"2338","DOI":"10.1016\/j.csbj.2022.05.015","volume":"20","author":"FJ Boehm","year":"2022","unstructured":"Boehm, F. J. & Zhou, X. Statistical methods for Mendelian randomization in genome-wide association studies: A review. Comput. Struct. Biotechnol. J. 20, 2338\u20132351. https:\/\/doi.org\/10.1016\/j.csbj.2022.05.015 (2022).","journal-title":"Comput. Struct. Biotechnol. J."},{"issue":"6","key":"91715_CR20","doi-asserted-by":"publisher","first-page":"e1008164","DOI":"10.1371\/journal.pgen.1008164","volume":"15","author":"KJA Johnston","year":"2019","unstructured":"Johnston, K. J. A. et al. Genome-wide association study of multisite chronic pain in UK biobank. PLoS Genet. 15 (6), e1008164. https:\/\/doi.org\/10.1371\/journal.pgen.1008164 (2019).","journal-title":"PLoS Genet."},{"issue":"5","key":"91715_CR21","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1038\/s41588-024-01707-9","volume":"56","author":"CM Nievergelt","year":"2024","unstructured":"Nievergelt, C. M. et al. Genome-wide association analyses identify 95 risk loci and provide insights into the neurobiology of post-traumatic stress disorder. Nat. Genet. 56 (5), 792\u2013808. https:\/\/doi.org\/10.1038\/s41588-024-01707-9 (2024).","journal-title":"Nat. Genet."},{"issue":"7944","key":"91715_CR22","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1038\/s41586-022-05473-8","volume":"613","author":"MI Kurki","year":"2023","unstructured":"Kurki, M. I. et al. FinnGen provides genetic insights from a well-phenotyped isolated population. Nature 613 (7944), 508\u2013518. https:\/\/doi.org\/10.1038\/s41586-022-05473-8 (2023).","journal-title":"Nature"},{"issue":"4","key":"91715_CR23","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1002\/gepi.22522","volume":"47","author":"N Mounier","year":"2023","unstructured":"Mounier, N. & Kutalik, Z. Bias correction for inverse variance weighting Mendelian randomization. Genet. Epidemiol. 47 (4), 314\u2013331. https:\/\/doi.org\/10.1002\/gepi.22522 (2023).","journal-title":"Genet. Epidemiol."},{"key":"91715_CR24","doi-asserted-by":"publisher","unstructured":"Hemani, G. et al. The MR-Base platform supports systematic causal inference across the human phenome. Elife 7 https:\/\/doi.org\/10.7554\/eLife.34408 (2018).","DOI":"10.7554\/eLife.34408"},{"issue":"3","key":"91715_CR25","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1093\/ije\/dyr036","volume":"40","author":"S Burgess","year":"2011","unstructured":"Burgess, S. & Thompson, S. G. Avoiding bias from weak instruments in Mendelian randomization studies. Int. J. Epidemiol. 40 (3), 755\u2013764. https:\/\/doi.org\/10.1093\/ije\/dyr036 (2011).","journal-title":"Int. J. Epidemiol."},{"issue":"1","key":"91715_CR26","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1038\/s43856-024-00473-3","volume":"4","author":"A Xue","year":"2024","unstructured":"Xue, A. et al. Unravelling the complex causal effects of substance use behaviours on common diseases. Commun. Med. (Lond). 4 (1), 43. https:\/\/doi.org\/10.1038\/s43856-024-00473-3 (2024).","journal-title":"Commun. Med. (Lond)"},{"issue":"5","key":"91715_CR27","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1007\/s10654-017-0255-x","volume":"32","author":"S Burgess","year":"2017","unstructured":"Burgess, S. & Thompson, S. G. Interpreting findings from Mendelian randomization using the MR-Egger method. Eur. J. Epidemiol. 32 (5), 377\u2013389. https:\/\/doi.org\/10.1007\/s10654-017-0255-x (2017).","journal-title":"Eur. J. Epidemiol."},{"issue":"4","key":"91715_CR28","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1002\/gepi.21965","volume":"40","author":"J Bowden","year":"2016","unstructured":"Bowden, J., Davey Smith, G., Haycock, P. C. & Burgess, S. Consistent Estimation in Mendelian randomization with some invalid instruments using a weighted median estimator. Genet. Epidemiol. 40 (4), 304\u2013314. https:\/\/doi.org\/10.1002\/gepi.21965 (2016).","journal-title":"Genet. Epidemiol."},{"issue":"3","key":"91715_CR29","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1093\/genetics\/163.3.1153","volume":"163","author":"BG Milligan","year":"2003","unstructured":"Milligan, B. G. Maximum-likelihood Estimation of relatedness. Genetics 163 (3), 1153\u20131167. https:\/\/doi.org\/10.1093\/genetics\/163.3.1153 (2003).","journal-title":"Genetics"},{"issue":"6","key":"91715_CR30","doi-asserted-by":"publisher","first-page":"1985","DOI":"10.1093\/ije\/dyx102","volume":"46","author":"FP Hartwig","year":"2017","unstructured":"Hartwig, F. P., Davey Smith, G. & Bowden, J. Robust inference in summary data Mendelian randomization via the zero modal Pleiotropy assumption. Int. J. Epidemiol. 46 (6), 1985\u20131998. https:\/\/doi.org\/10.1093\/ije\/dyx102 (2017).","journal-title":"Int. J. Epidemiol."},{"issue":"1","key":"91715_CR31","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1038\/s41467-017-02317-2","volume":"9","author":"Z Zhu","year":"2018","unstructured":"Zhu, Z. et al. Causal associations between risk factors and common diseases inferred from GWAS summary data. Nat. Commun. 9 (1), 224. https:\/\/doi.org\/10.1038\/s41467-017-02317-2 (2018).","journal-title":"Nat. Commun."},{"issue":"5","key":"91715_CR32","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1038\/s41588-018-0099-7","volume":"50","author":"M Verbanck","year":"2018","unstructured":"Verbanck, M., Chen, C. Y., Neale, B. & Do, R. Detection of widespread horizontal Pleiotropy in causal relationships inferred from Mendelian randomization between complex traits and diseases. Nat. Genet. 50 (5), 693\u2013698. https:\/\/doi.org\/10.1038\/s41588-018-0099-7 (2018).","journal-title":"Nat. Genet."},{"issue":"4","key":"91715_CR33","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1093\/pm\/pnw065","volume":"18","author":"DA Fishbain","year":"2017","unstructured":"Fishbain, D. A., Pulikal, A., Lewis, J. E. & Gao, J. Chronic pain types differ in their reported prevalence of post -Traumatic stress disorder (PTSD) and there is consistent evidence that chronic pain is associated with PTSD: an evidence-Based structured systematic review. Pain Med. 18 (4), 711\u2013735. https:\/\/doi.org\/10.1093\/pm\/pnw065 (2017).","journal-title":"Pain Med."},{"issue":"5","key":"91715_CR34","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1037\/hea0000859","volume":"39","author":"L Stahlschmidt","year":"2020","unstructured":"Stahlschmidt, L., Rosenkranz, F., Dobe, M. & Wager, J. Posttraumatic stress disorder in children and adolescents with chronic pain. Health Psychol. 39 (5), 463\u2013470. https:\/\/doi.org\/10.1037\/hea0000859 (2020).","journal-title":"Health Psychol."},{"issue":"10","key":"91715_CR35","doi-asserted-by":"publisher","first-page":"2277","DOI":"10.1097\/j.pain.0000000000000642","volume":"157","author":"M Noel","year":"2016","unstructured":"Noel, M. et al. Posttraumatic stress disorder symptoms in youth with vs without chronic pain. Pain 157 (10), 2277\u20132284. https:\/\/doi.org\/10.1097\/j.pain.0000000000000642 (2016).","journal-title":"Pain"},{"issue":"1","key":"91715_CR36","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s10194-023-01612-2","volume":"24","author":"C Yao","year":"2023","unstructured":"Yao, C. et al. Exploring the bidirectional relationship between pain and mental disorders: a comprehensive Mendelian randomization study. J. Headache Pain. 24 (1), 82. https:\/\/doi.org\/10.1186\/s10194-023-01612-2 (2023).","journal-title":"J. Headache Pain"},{"issue":"7","key":"91715_CR37","doi-asserted-by":"publisher","first-page":"2043","DOI":"10.1038\/s41380-024-02465-0","volume":"29","author":"J Balit","year":"2024","unstructured":"Balit, J., Erlangsen, A., Docherty, A., Turecki, G. & Orri, M. Association of chronic pain with suicide attempt and death by suicide: a two-sample Mendelian randomization. Mol. Psychiatry. 29 (7), 2043\u20132049. https:\/\/doi.org\/10.1038\/s41380-024-02465-0 (2024).","journal-title":"Mol. Psychiatry"},{"issue":"2\u20133","key":"91715_CR38","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/0304-3959(96)03038-2","volume":"66","author":"ME Geisser","year":"1996","unstructured":"Geisser, M. E., Roth, R. S., Bachman, J. E. & Eckert, T. A. The relationship between symptoms of post-traumatic stress disorder and pain, affective disturbance and disability among patients with accident and non-accident related pain. Pain 66 (2\u20133), 207\u2013214. https:\/\/doi.org\/10.1016\/0304-3959(96)03038-2 (1996).","journal-title":"Pain"},{"issue":"4","key":"91715_CR39","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1097\/ajp.0000000000000115","volume":"31","author":"ER Scioli-Salter","year":"2015","unstructured":"Scioli-Salter, E. R. et al. The shared neuroanatomy and neurobiology of comorbid chronic pain and PTSD: therapeutic implications. Clin. J. Pain. 31 (4), 363\u2013374. https:\/\/doi.org\/10.1097\/ajp.0000000000000115 (2015).","journal-title":"Clin. J. Pain"},{"key":"91715_CR40","doi-asserted-by":"publisher","unstructured":"Steardo, L. Jr. et al. Endocannabinoid system as therapeutic target of PTSD: A systematic review. Life (Basel). 11 (3). https:\/\/doi.org\/10.3390\/life11030214 (2021).","DOI":"10.3390\/life11030214"},{"issue":"3","key":"91715_CR41","doi-asserted-by":"publisher","first-page":"455","DOI":"10.3758\/s13415-020-00782-9","volume":"20","author":"MM Quinones","year":"2020","unstructured":"Quinones, M. M., Gallegos, A. M., Lin, F. V. & Heffner, K. Dysregulation of inflammation, neurobiology, and cognitive function in PTSD: an integrative review. Cogn. Affect. Behav. Neurosci. 20 (3), 455\u2013480. https:\/\/doi.org\/10.3758\/s13415-020-00782-9 (2020).","journal-title":"Cogn. Affect. Behav. Neurosci."},{"issue":"10","key":"91715_CR42","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1007\/s10654-018-0424-6","volume":"33","author":"S Burgess","year":"2018","unstructured":"Burgess, S. & Labrecque, J. A. Mendelian randomization with a binary exposure variable: interpretation and presentation of causal estimates. Eur. J. Epidemiol. 33 (10), 947\u2013952. https:\/\/doi.org\/10.1007\/s10654-018-0424-6 (2018).","journal-title":"Eur. J. Epidemiol."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-91715-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-91715-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-91715-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T19:29:59Z","timestamp":1741030199000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-91715-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,3]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["91715"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-91715-4","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,3]]},"assertion":[{"value":"22 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 February 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study used publicly available de-identified datasets for secondary analyses and therefore did not require additional ethics approval or consent to participate.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}],"article-number":"7413"}}