{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:15:47Z","timestamp":1790381747139,"version":"4.1.0"},"reference-count":65,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T00:00:00Z","timestamp":1745020800000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020320","name":"Institut pour la Recherche en Sant\u00e9 Publique","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020320","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR-11-INBS-0002"],"award-info":[{"award-number":["ANR-11-INBS-0002"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Caisse nationale d\u2019assurance maladie"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,3,11]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Uncertainty exists as to what extent common risk factors are involved in the associations of unemployment with major health outcomes and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective and prospective observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A large population-based French cohort (CONSTANCES).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>99 430 adults at baseline who have been exposed to unemployment during their lifetime and 54 679 of them who were followed for 7 years after baseline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>Testing the mediating roles of several risk factors at baseline in the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates during a 7-year follow-up. Direct and indirect effects were calculated for each risk factor and all together using logistic regression models adjusted for major confounders including sex, age, parental histories of cardiovascular disease and cancer, social position and working conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Estimates (95% CIs) of the direct and indirect effects for smoking are 0.0083 (0.0044 to 0.0122), p&lt;0.0001 and 0.0010 (0.0007 to 0.0014), p&lt;0.0001 on cardiovascular disease rate; 0.0059 (0.0028 to 0.0089), p=0.0002 and 0.0007 (0.0004 to 0.0010), p&lt;0.0001 on cancer rate; 0.0105 (0.0058 to 0.0151), p&lt;0.0001 and 0.0010 (0.0005 to 0.0014), p&lt;0.0001 on all-cause mortality. The figures for alcohol consumption are, respectively, 0.0076 (0.0034 to 0.0118), p=0.0004 and 0.0004 (0.0002 to 0.0005), p=0.0006; 0.0067 (0.0035 to 0.0100), p&lt;0.0001 and 0.0004 (0.0002 to 0.0005), p&lt;0.0001; 0.0114 (0.0064 to 0.0164), p&lt;0.0001 and 0.0004 (0.0001 to 0.0006), p=0.0009. For depressive symptoms, 0.0084 (0.0040to 0.0128), p=0.0002 and 0.0007 (0.0002 to 0.0011), p=0.005; 0.0053 (0.0017 to 0.0089), p=0.004 and 0.0001 (\u22120.0002 to 0.0005), p=0.51; 0.0088 (0.0031 to 0.0144), p=0.002 and 0.0010 (0.0004 to 0.0015), p=0.0005. For leisure-time physical inactivity, 0.0083 (0.0044 to 0.0122), p&lt;0.0001 and 0.0003 (0.0001 to 0.0005), p=0.0006; 0.0057 (0.0026 to 0.0088), p=0.0004 and 0.0002 (0.0001 to 0.0003), p=0.002; 0.0105 (0.0058 to 0.0152), p&lt;0.0001 and 0.0004 (0.0002 to 0.0007), p&lt;0.0001. For blood triglycerides, 0.0080 (0.0042 to 0.0119), p&lt;0.0001 and 0.0005 (0.0004 to 0.0007), p&lt;0.0001; 0.0057 (0.0026 to 0.0087), p=0.0003 and 0.0001 (\u22120.0001 to 0.0002), p=0.32; 0.0103 (0.0057 to 0.0149), p&lt;0.0001 and 0.0002 (0.0000 to 0.0004), p=0.06. The figures for all risk factors when tested together were 0.0075 (0.0022 to 0.0128), p=0.005 and 0.0020 (0.0011 to 0.0027), p&lt;0.0001; 0.0052 (0.0011 to 0.0093), p=0.01 and 0.015 (0.0009 to 0.0020), p&lt;0.0001; 0.0102 (0.0035 to 0.0169), p=0.003 and 0.0022 (0.0011 to 0.0031), p&lt;0.0001.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These analyses show that common risk factors such as smoking, alcohol consumption, depressive symptoms, leisure-time physical inactivity and blood triglycerides mediate up to 10% of the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates when tested separately and approximately 20% when tested all together. This highlights the existence of other major mediating pathways that have yet to be identified.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-096607","type":"journal-article","created":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T02:50:18Z","timestamp":1745117418000},"page":"e096607","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Involvement of common risk factors in the associations between lifetime unemployment exposure, major health outcomes and mortality: a retrospective and prospective study in a large population-based French cohort"],"prefix":"10.1136","volume":"15","author":[{"given":"Marina","family":"Sanchez Rico","sequence":"first","affiliation":[{"name":"DMU Psychiatrie et Addictologie, H\u00f4pital Corentin-Celton, Universit\u00e9 Paris Cit\u00e9, AP-HP, Issy-les-Moulineaux, France"},{"name":"UMR_1266, INSERM, Issy-les-Moulineaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8046-7919","authenticated-orcid":false,"given":"Emmanuel","family":"Wiernik","sequence":"additional","affiliation":[{"name":"UMS_011, INSERM, Villejuif, France"},{"name":"Universit\u00e9 Paris Cit\u00e9, Paris, France"},{"name":"Universit\u00e9 Paris-Saclay, Gif-sur-Yvette, France"},{"name":"Universit\u00e9 de Versailles Saint-Quentin-en-Yvelines, Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeline","family":"Renuy","sequence":"additional","affiliation":[{"name":"UMS_011, INSERM, Villejuif, France"},{"name":"Universit\u00e9 Paris Cit\u00e9, Paris, France"},{"name":"Universit\u00e9 Paris-Saclay, Gif-sur-Yvette, France"},{"name":"Universit\u00e9 de Versailles Saint-Quentin-en-Yvelines, Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofiane","family":"Kab","sequence":"additional","affiliation":[{"name":"UMS_011, INSERM, Villejuif, France"},{"name":"Universit\u00e9 Paris Cit\u00e9, Paris, France"},{"name":"Universit\u00e9 Paris-Saclay, Gif-sur-Yvette, France"},{"name":"Universit\u00e9 de Versailles Saint-Quentin-en-Yvelines, Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Hoertel","sequence":"additional","affiliation":[{"name":"DMU Psychiatrie et Addictologie, H\u00f4pital Corentin-Celton, Universit\u00e9 Paris Cit\u00e9, AP-HP, Issy-les-Moulineaux, France"},{"name":"UMR_1266, INSERM, Issy-les-Moulineaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6161-5880","authenticated-orcid":false,"given":"Marcel","family":"Goldberg","sequence":"additional","affiliation":[{"name":"UMS_011, INSERM, Villejuif, France"},{"name":"Universit\u00e9 Paris Cit\u00e9, Paris, France"},{"name":"Universit\u00e9 Paris-Saclay, Gif-sur-Yvette, France"},{"name":"Universit\u00e9 de Versailles Saint-Quentin-en-Yvelines, Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Zins","sequence":"additional","affiliation":[{"name":"UMS_011, INSERM, Villejuif, France"},{"name":"Universit\u00e9 Paris Cit\u00e9, Paris, France"},{"name":"Universit\u00e9 Paris-Saclay, Gif-sur-Yvette, France"},{"name":"Universit\u00e9 de Versailles Saint-Quentin-en-Yvelines, Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4611-1892","authenticated-orcid":false,"given":"Pierre","family":"Meneton","sequence":"additional","affiliation":[{"name":"UMR_1142 LIMICS, INSERM, Paris, France"},{"name":"Sorbonne Universite, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,4,19]]},"reference":[{"key":"2025121603200892000_15.4.e096607.1","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdz100"},{"key":"2025121603200892000_15.4.e096607.2","doi-asserted-by":"publisher","DOI":"10.1001\/2013.jamainternmed.447"},{"key":"2025121603200892000_15.4.e096607.3","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.1835"},{"key":"2025121603200892000_15.4.e096607.4","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2013-101721"},{"key":"2025121603200892000_15.4.e096607.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00420-014-0997-7"},{"key":"2025121603200892000_15.4.e096607.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0288747","article-title":"Cardiovascular burden and unemployment: A retrospective study in a large population-based French cohort","volume":"18","author":"Sanchez Rico","year":"2023","journal-title":"PLoS One"},{"key":"2025121603200892000_15.4.e096607.7","unstructured":"Lynge E . Unemployment and cancer: a literature review. IARC Sci Publ 1997;343\u201351."},{"key":"2025121603200892000_15.4.e096607.8","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-soc-071913-043237"},{"key":"2025121603200892000_15.4.e096607.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2011.01.005"},{"key":"2025121603200892000_15.4.e096607.10","doi-asserted-by":"crossref","DOI":"10.1016\/j.ehb.2021.101042","article-title":"Unemployment and sleep: evidence from the United States and Europe","volume":"43","author":"Blanchflower","year":"2021","journal-title":"Econ Hum Biol"},{"key":"2025121603200892000_15.4.e096607.11","doi-asserted-by":"publisher","DOI":"10.1097\/JOM.0b013e318209915e"},{"key":"2025121603200892000_15.4.e096607.12","doi-asserted-by":"publisher","DOI":"10.2174\/1874473711104010004"},{"key":"2025121603200892000_15.4.e096607.13","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.ypmed.2016.12.045","article-title":"Unemployment, underweight, and obesity: Findings from Understanding Society (UKHLS)","volume":"97","author":"Hughes","year":"2017","journal-title":"Prev Med"},{"key":"2025121603200892000_15.4.e096607.14","doi-asserted-by":"publisher","DOI":"10.1177\/1403494814560845"},{"key":"2025121603200892000_15.4.e096607.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvb.2009.01.001"},{"key":"2025121603200892000_15.4.e096607.16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0232262","article-title":"Association between unemployment and the co-occurrence and clustering of common risky health behaviors: Findings from the Constances cohort","volume":"15","author":"Plessz","year":"2020","journal-title":"PLoS One"},{"key":"2025121603200892000_15.4.e096607.17","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.pcd.2017.03.010","article-title":"Accumulated exposure to unemployment is related to impaired glucose metabolism in middle-aged men: A follow-up of the Northern Finland Birth Cohort 1966","volume":"11","author":"Rautio","year":"2017","journal-title":"Prim Care Diabetes"},{"key":"2025121603200892000_15.4.e096607.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-074835","article-title":"Distinct cardiovascular and cancer burdens associated with social position, work environment and unemployment: a cross-sectional and retrospective study in a large population-based French cohort","volume":"13","author":"Sanchez Rico","year":"2023","journal-title":"BMJ Open"},{"key":"2025121603200892000_15.4.e096607.19","doi-asserted-by":"publisher","DOI":"10.1177\/0002764213487347"},{"key":"2025121603200892000_15.4.e096607.20","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2005.041350"},{"key":"2025121603200892000_15.4.e096607.21","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000228"},{"key":"2025121603200892000_15.4.e096607.22","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.88.4.1973"},{"key":"2025121603200892000_15.4.e096607.23","unstructured":"Kogevinas M , Pearce N , Susser M , et al . Social inequalities and cancer. International Agency for Research on Cancer Scientific Publications, 1997."},{"key":"2025121603200892000_15.4.e096607.24","unstructured":"Vaccarella S , Lortet-Tieulent J , Saracci R , et al . Reducing social inequalities in cancer: setting priorities for research. International Agency for Research on Cancer Scientific Publications, 2019."},{"key":"2025121603200892000_15.4.e096607.25","doi-asserted-by":"crossref","DOI":"10.1186\/1479-5868-9-116","article-title":"Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review","volume":"9","author":"Beenackers","year":"2012","journal-title":"Int J Behav Nutr Phys Act"},{"key":"2025121603200892000_15.4.e096607.26","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agl073"},{"key":"2025121603200892000_15.4.e096607.27","doi-asserted-by":"publisher","DOI":"10.2190\/PM.40.1.i"},{"key":"2025121603200892000_15.4.e096607.28","first-page":"127","article-title":"Sleep health disparity: the putative role of race, ethnicity and socioeconomic status","volume":"2","author":"Jehan","year":"2018","journal-title":"Sleep Med Disord"},{"key":"2025121603200892000_15.4.e096607.29","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.21.2348"},{"key":"2025121603200892000_15.4.e096607.30","doi-asserted-by":"publisher","DOI":"10.1093\/epirev\/mxm001"},{"key":"2025121603200892000_15.4.e096607.31","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.82.6.816"},{"key":"2025121603200892000_15.4.e096607.32","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.117.008073","article-title":"Association between work-related stress and coronary heart disease: a review of prospective studies through the job strain, effort-reward balance, and organizational justice models","volume":"7","author":"Sara","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2025121603200892000_15.4.e096607.33","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2017-104858"},{"key":"2025121603200892000_15.4.e096607.34","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws336"},{"key":"2025121603200892000_15.4.e096607.35","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0040101","article-title":"Job strain and alcohol intake: a collaborative meta-analysis of individual-participant data from 140,000 men and women","volume":"7","author":"Heikkil\u00e4","year":"2012","journal-title":"PLoS One"},{"key":"2025121603200892000_15.4.e096607.36","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0035463","article-title":"Job strain and tobacco smoking: an individual-participant data meta-analysis of 166,130 adults in 15 European studies","volume":"7","author":"Heikkil\u00e4","year":"2012","journal-title":"PLoS One"},{"key":"2025121603200892000_15.4.e096607.37","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.2105\/AJPH.2012.301153","article-title":"Job strain and ambulatory blood pressure: a meta-analysis and systematic review","volume":"103","author":"Landsbergis","year":"2013","journal-title":"Am J Public Health"},{"key":"2025121603200892000_15.4.e096607.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2014.10.010"},{"key":"2025121603200892000_15.4.e096607.39","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2011.02482.x"},{"key":"2025121603200892000_15.4.e096607.40","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-2936"},{"key":"2025121603200892000_15.4.e096607.41","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-015-1954-4","article-title":"A systematic review including meta-analysis of work environment and depressive symptoms","volume":"15","author":"Theorell","year":"2015","journal-title":"BMC Public Health"},{"key":"2025121603200892000_15.4.e096607.42","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1007\/s10654-015-0096-4","article-title":"The French CONSTANCES population-based cohort: design, inclusion and follow-up","volume":"30","author":"Zins","year":"2015","journal-title":"Eur J Epidemiol"},{"key":"2025121603200892000_15.4.e096607.43","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0230661","article-title":"Social deprivation among socio-economic contrasted french areas: Using item response theory analysis to assess differential item functioning of the EPICES questionnaire in stroke patients","volume":"15","author":"Guilloteau","year":"2020","journal-title":"PLoS One"},{"key":"2025121603200892000_15.4.e096607.44","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.021373","article-title":"Respective mediating effects of social position and work environment on the incidence of common cardiovascular risk factors","volume":"11","author":"Hoertel","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2025121603200892000_15.4.e096607.45","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(03)00351-4"},{"key":"2025121603200892000_15.4.e096607.46","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-016-3439-5","article-title":"High quality standards for a large-scale prospective population-based observational cohort: Constances","volume":"16","author":"Ruiz","year":"2016","journal-title":"BMC Public Health"},{"key":"2025121603200892000_15.4.e096607.47","unstructured":"Rubin DB . Multiple imputation for nonresponse in surveys. John Wiley & Sons, 2004."},{"key":"2025121603200892000_15.4.e096607.48","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-018-0654-z","article-title":"Comparison of logistic-regression based methods for simple mediation analysis with a dichotomous outcome variable","volume":"19","author":"Rijnhart","year":"2019","journal-title":"BMC Med Res Methodol"},{"key":"2025121603200892000_15.4.e096607.49","doi-asserted-by":"publisher","DOI":"10.2307\/270723"},{"key":"2025121603200892000_15.4.e096607.50","unstructured":"Hayes AJ . Introduction to mediation, moderation, and conditional process analysis. Guilford Press, 2022."},{"key":"2025121603200892000_15.4.e096607.51","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2014.03.034"},{"key":"2025121603200892000_15.4.e096607.52","doi-asserted-by":"crossref","first-page":"35","DOI":"10.15288\/jsad.2014.75.35","article-title":"Alcohol-related morbidity and mortality following involuntary job loss: evidence from Swedish register data","volume":"75","author":"Eliason","year":"2014","journal-title":"J Stud Alcohol Drugs"},{"key":"2025121603200892000_15.4.e096607.53","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.socscimed.2015.06.003","article-title":"Losing jobs and lighting up: employment experiences and smoking in the great recession","volume":"138","author":"Golden","year":"2015","journal-title":"Soc Sci Med"},{"key":"2025121603200892000_15.4.e096607.54","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1111\/irel.12019","article-title":"Does unemployment lead to greater alcohol consumption?","volume":"52","author":"Popovici","year":"2013","journal-title":"Ind Relat (Berkeley)"},{"key":"2025121603200892000_15.4.e096607.55","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0222361","article-title":"Alcohol, tobacco and cannabis use are associated with job loss at follow-up: Findings from the CONSTANCES cohort","volume":"14","author":"Airagnes","year":"2019","journal-title":"PLoS One"},{"key":"2025121603200892000_15.4.e096607.56","doi-asserted-by":"publisher","DOI":"10.1016\/S0033-3506(05)80436-6"},{"key":"2025121603200892000_15.4.e096607.57","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1080\/08870446.2016.1247841","article-title":"Unemployment as a chronic stressor: A systematic review of cortisol studies","volume":"32","author":"Sumner","year":"2017","journal-title":"Psychol Health"},{"key":"2025121603200892000_15.4.e096607.58","doi-asserted-by":"publisher","DOI":"10.1002\/hec.1361"},{"key":"2025121603200892000_15.4.e096607.59","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.puhe.2019.10.005","article-title":"Self-reported health versus biomarkers: does unemployment lead to worse health?","volume":"179","author":"Johansson","year":"2020","journal-title":"Public Health (Fairfax)"},{"key":"2025121603200892000_15.4.e096607.60","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0131521","article-title":"How to establish and follow up a large prospective cohort study in the 21st century--lessons from UK COSMOS","volume":"10","author":"Toledano","year":"2015","journal-title":"PLoS ONE"},{"key":"2025121603200892000_15.4.e096607.61","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1093\/ije\/dyac058","article-title":"Measuring education in the context of health inequalities","volume":"51","author":"Khalatbari-Soltani","year":"2022","journal-title":"Int J Epidemiol"},{"key":"2025121603200892000_15.4.e096607.62","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61124-7"},{"key":"2025121603200892000_15.4.e096607.63","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2008.077354"},{"key":"2025121603200892000_15.4.e096607.64","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckm084"},{"key":"2025121603200892000_15.4.e096607.65","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2014.12.017"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-096607","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T11:20:24Z","timestamp":1765884024000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-096607"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":65,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,19]]},"published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1136\/bmjopen-2024-096607"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-096607","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]}}}