{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T15:49:14Z","timestamp":1778600954585,"version":"3.51.4"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T00:00:00Z","timestamp":1721692800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T00:00:00Z","timestamp":1721692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Sichuan Health Commission","award":["No. 23LCYJ044"],"award-info":[{"award-number":["No. 23LCYJ044"]}]},{"name":"Department of Human Resources and Social Security of Sichuan Province","award":["No.2021-11"],"award-info":[{"award-number":["No.2021-11"]}]},{"name":"Chengdu Municipal Health commission","award":["No.2021200&2022392"],"award-info":[{"award-number":["No.2021200&2022392"]}]},{"name":"The Third People\u2019s Hospital of Chengdu Scientific Research Project","award":["2023PI17"],"award-info":[{"award-number":["2023PI17"]}]},{"name":"Science and Technology Bureau of Chengdu","award":["2019-YF05\u201300523-SN"],"award-info":[{"award-number":["2019-YF05\u201300523-SN"]}]},{"name":"Third People\u2019s Hospital of Chengdu Clinical Research Program","award":["CSY-YN-01-2023-011, 076, 077"],"award-info":[{"award-number":["CSY-YN-01-2023-011, 076, 077"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to investigate the association of cystatin C, serum creatinine and sarcopenia index with cardiovascular and all-cause death in general population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data of participants from the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2004 were used and all participants were followed up regularly until December 31, 2019. Multivariable Cox analysis was used to investigate the association of cystatin C, serum creatinine and sarcopenia index with cardiovascular and all-cause death. Restricted cubic spline was conducted to evaluate the nonlinear association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 9894 participants with a mean age of 45.64 years were enrolled and followed up for a mean duration of 15.62\u2009\u00b1\u20094.68 years. Approximately 50.3% were male and there were a total of 2681 all-cause deaths and 691 cardiovascular deaths recorded during the follow-up period. In final adjusted model, compared with the first quartile of cystatin C (&lt;\u20090.659\u00a0mg\/L), the risk of cardiovascular and all-cause death increased 2.36-fold and 1.71-fold for participants in the fourth quartile (\u2265\u20090.877\u00a0mg\/L) (HR: 3.36, 95% CI: 2.06\u20135.46,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001; HR: 2.71, 95% CI: 2.17\u20133.38,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001; respectively). Furthermore, a higher sarcopenia index (&lt;\u200988.41 vs. \u2265125.52) was associated with the reduced risk of cardiovascular death (HR: 0.41, 95% CI: 0.31\u20130.53,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) as well as all-cause death (HR: 0.41, 95% CI: 0.35\u20130.49,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Additionally, restricted cubic splines showed that there was a nonlinear relationship between sarcopenia index levels and all-cause death while there was a linear relationship between sarcopenia index levels and cardiovascular death.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher sarcopenia index was associated with the decreased risk of cardiovascular and all-cause death in general population in the United States. Elevated cystatin C was positively associated with cardiovascular and all-cause death.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-024-19137-x","type":"journal-article","created":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T12:10:40Z","timestamp":1721736640000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Cystatin C and sarcopenia index are associated with cardiovascular and all-cause death among adults in the United States"],"prefix":"10.1186","volume":"24","author":[{"given":"Tianbo","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuxin","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaohan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhen","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gang","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junbo","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,7,23]]},"reference":[{"issue":"20","key":"19137_CR1","doi-asserted-by":"publisher","first-page":"2529","DOI":"10.1016\/j.jacc.2019.10.009","volume":"74","author":"GA Mensah","year":"2019","unstructured":"Mensah GA, Roth GA, Fuster V. The Global Burden of Cardiovascular diseases and Risk factors: 2020 and Beyond. J Am Coll Cardiol. 2019;74(20):2529\u201332.","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"19137_CR2","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1007\/s44197-021-00024-2","volume":"12","author":"Z Wang","year":"2022","unstructured":"Wang Z, Du A, Liu H, Wang Z, Hu J. Systematic analysis of the Global, Regional and National Burden of Cardiovascular diseases from 1990 to 2017. J Epidemiol Glob Health. 2022;12(1):92\u2013103.","journal-title":"J Epidemiol Glob Health"},{"issue":"25","key":"19137_CR3","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","volume":"76","author":"GA Roth","year":"2020","unstructured":"Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, et al. Global Burden of Cardiovascular diseases and Risk factors, 1990\u20132019: Update from the GBD 2019 study. J Am Coll Cardiol. 2020;76(25):2982\u20133021.","journal-title":"J Am Coll Cardiol"},{"issue":"5","key":"19137_CR4","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1053\/j.ajkd.2021.04.016","volume":"78","author":"LA Inker","year":"2021","unstructured":"Inker LA, Titan S. Measurement and estimation of GFR for Use in Clinical Practice: Core Curriculum 2021. Am J Kidney Dis. 2021;78(5):736\u201349.","journal-title":"Am J Kidney Dis"},{"issue":"2","key":"19137_CR5","first-page":"47","volume":"29","author":"JS Chew","year":"2008","unstructured":"Chew JS, Saleem M, Florkowski CM, George PM. Cystatin C\u2013a paradigm of evidence based laboratory medicine. Clin Biochem Rev. 2008;29(2):47\u201362.","journal-title":"Clin Biochem Rev"},{"issue":"8","key":"19137_CR6","doi-asserted-by":"publisher","first-page":"2146","DOI":"10.1093\/ndt\/gft213","volume":"28","author":"J Park","year":"2013","unstructured":"Park J, Mehrotra R, Rhee CM, Molnar MZ, Lukowsky LR, Patel SS, Nissenson AR, Kopple JD, Kovesdy CP, Kalantar-Zadeh K. Serum creatinine level, a surrogate of muscle mass, predicts mortality in peritoneal dialysis patients. Nephrol Dial Transpl. 2013;28(8):2146\u201355.","journal-title":"Nephrol Dial Transpl"},{"issue":"1","key":"19137_CR7","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1093\/ageing\/afy169","volume":"48","author":"AJ Cruz-Jentoft","year":"2019","unstructured":"Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16\u201331.","journal-title":"Age Ageing"},{"issue":"1","key":"19137_CR8","doi-asserted-by":"publisher","first-page":"e23","DOI":"10.1097\/CCM.0000000000002013","volume":"45","author":"KB Kashani","year":"2017","unstructured":"Kashani KB, Frazee EN, Kukralova L, Sarvottam K, Herasevich V, Young PM, Kashyap R, Lieske JC. Evaluating muscle Mass by using markers of kidney function: development of the Sarcopenia Index. Crit Care Med. 2017;45(1):e23\u20139.","journal-title":"Crit Care Med"},{"key":"19137_CR9","doi-asserted-by":"publisher","first-page":"897774","DOI":"10.3389\/fnut.2022.897774","volume":"9","author":"S Shi","year":"2022","unstructured":"Shi S, Jiang Y, Chen W, Chen K, Liao Y, Huang K. Diagnostic and prognostic value of the Creatinine\/Cystatin C ratio for low muscle mass evaluation among US adults. Front Nutr. 2022;9:897774.","journal-title":"Front Nutr"},{"issue":"3","key":"19137_CR10","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1080\/1354750X.2021.1989489","volume":"27","author":"E Jung","year":"2022","unstructured":"Jung E, Ro YS, Ryu HH, Kong SY, Shin SD, Hwang SO. Cystatin C and mortality risk in the general population: systematic review and dose response meta-analysis. Biomarkers. 2022;27(3):222\u20139.","journal-title":"Biomarkers"},{"issue":"18","key":"19137_CR11","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1016\/j.clinbiochem.2017.07.016","volume":"50","author":"T Breidthardt","year":"2017","unstructured":"Breidthardt T, Sabti Z, Ziller R, Rassouli F, Twerenbold R, Kozhuharov N, Gayat E, Shrestha S, Barata S, Badertscher P, et al. Diagnostic and prognostic value of cystatin C in acute heart failure. Clin Biochem. 2017;50(18):1007\u201313.","journal-title":"Clin Biochem"},{"issue":"1","key":"19137_CR12","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.jtcvs.2016.02.070","volume":"152","author":"A Dardashti","year":"2016","unstructured":"Dardashti A, Nozohoor S, Algotsson L, Ederoth P, Bjursten H. The predictive value of s-cystatin C for mortality after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2016;152(1):139\u201346.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"3","key":"19137_CR13","doi-asserted-by":"publisher","first-page":"e13440","DOI":"10.1111\/eci.13440","volume":"51","author":"Y Sun","year":"2021","unstructured":"Sun Y, Lu Q, Cheng B, Tao X. Prognostic value of cystatin C in patients with acute coronary syndrome: a systematic review and meta-analysis. Eur J Clin Invest. 2021;51(3):e13440.","journal-title":"Eur J Clin Invest"},{"issue":"3","key":"19137_CR14","doi-asserted-by":"publisher","first-page":"e14214","DOI":"10.1016\/j.heliyon.2023.e14214","volume":"9","author":"L Zhang","year":"2023","unstructured":"Zhang L, Jin J, Tu YY, Zhao Z, Tao J, Zhang XY. Serum creatinine\/cystatin C ratio is a predictor of all-cause mortality for older adults over 80 years. Heliyon. 2023;9(3):e14214.","journal-title":"Heliyon"},{"key":"19137_CR15","doi-asserted-by":"crossref","unstructured":"Lee HS, Park KW, Kang J, Ki YJ, Chang M, Han JK, Yang HM, Kang HJ, Koo BK, Kim HS. Sarcopenia Index as a predictor of clinical outcomes in older patients with coronary artery disease. J Clin Med 2020, 9(10).","DOI":"10.3390\/jcm9103121"},{"issue":"9","key":"19137_CR16","doi-asserted-by":"publisher","first-page":"1733","DOI":"10.1016\/j.numecd.2023.05.031","volume":"33","author":"T Sunayama","year":"2023","unstructured":"Sunayama T, Fujimoto Y, Matsue Y, Dotare T, Daichi M, Yatsu S, Ishiwata S, Nakamura Y, Akama Y, Tsujimura Y, et al. Prognostic value of estimating appendicular muscle mass in heart failure using creatinine\/cystatin C. Nutr Metab Cardiovasc Dis. 2023;33(9):1733\u20139.","journal-title":"Nutr Metab Cardiovasc Dis"},{"issue":"6","key":"19137_CR17","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1016\/j.clnu.2023.03.023","volume":"42","author":"E Ashton","year":"2023","unstructured":"Ashton E, Arrondeau J, Jouinot A, Boudou-Rouquette P, Hirsch L, Huillard O, Ulmann G, Lupo-Mansuet A, Damotte D, Wislez M, et al. Impact of Sarcopenia indexes on survival and severe immune acute toxicity in metastatic non-small cell lung cancer patients treated with PD-1 immune checkpoint inhibitors. Clin Nutr. 2023;42(6):944\u201353.","journal-title":"Clin Nutr"},{"issue":"4","key":"19137_CR18","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.1002\/jcsm.13006","volume":"13","author":"CY Jung","year":"2022","unstructured":"Jung CY, Kim HW, Han SH, Yoo TH, Kang SW, Park JT. Creatinine-cystatin C ratio and mortality in cancer patients: a retrospective cohort study. J Cachexia Sarcopenia Muscle. 2022;13(4):2064\u201372.","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"6","key":"19137_CR19","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1139\/apnm-2020-0588","volume":"46","author":"S Oftedal","year":"2021","unstructured":"Oftedal S, Aguiar EJ, Duncan MJ. Associations between multiple positive health behaviors and cardiometabolic risk using 3 alternative measures of physical activity: NHANES 2005\u20132006. Appl Physiol Nutr Metab. 2021;46(6):617\u201325.","journal-title":"Appl Physiol Nutr Metab"},{"issue":"23","key":"19137_CR20","doi-asserted-by":"publisher","first-page":"1930","DOI":"10.1016\/j.jacc.2010.04.069","volume":"56","author":"CK Wu","year":"2010","unstructured":"Wu CK, Lin JW, Caffrey JL, Chang MH, Hwang JJ, Lin YS. Cystatin C and long-term mortality among subjects with normal creatinine-based estimated glomerular filtration rates: NHANES III (Third National Health and Nutrition Examination Survey). J Am Coll Cardiol. 2010;56(23):1930\u20136.","journal-title":"J Am Coll Cardiol"},{"issue":"20","key":"19137_CR21","doi-asserted-by":"publisher","first-page":"2049","DOI":"10.1056\/NEJMoa043161","volume":"352","author":"MG Shlipak","year":"2005","unstructured":"Shlipak MG, Sarnak MJ, Katz R, Fried LF, Seliger SL, Newman AB, Siscovick DS, Stehman-Breen C. Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med. 2005;352(20):2049\u201360.","journal-title":"N Engl J Med"},{"issue":"5","key":"19137_CR22","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1111\/joim.12169","volume":"275","author":"P Svensson-Farbom","year":"2014","unstructured":"Svensson-Farbom P, Ohlson Andersson M, Almgren P, Hedblad B, Engstrom G, Persson M, Christensson A, Melander O. Cystatin C identifies cardiovascular risk better than creatinine-based estimates of glomerular filtration in middle-aged individuals without a history of cardiovascular disease. J Intern Med. 2014;275(5):506\u201321.","journal-title":"J Intern Med"},{"issue":"11","key":"19137_CR23","doi-asserted-by":"publisher","first-page":"1932","DOI":"10.1373\/clinchem.2009.128397","volume":"55","author":"N Taglieri","year":"2009","unstructured":"Taglieri N, Koenig W, Kaski JC. Cystatin C and cardiovascular risk. Clin Chem. 2009;55(11):1932\u201343.","journal-title":"Clin Chem"},{"issue":"8","key":"19137_CR24","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1161\/01.ATV.0000134530.27208.41","volume":"24","author":"J Liu","year":"2004","unstructured":"Liu J, Sukhova GK, Sun JS, Xu WH, Libby P, Shi GP. Lysosomal cysteine proteases in atherosclerosis. Arterioscler Thromb Vasc Biol. 2004;24(8):1359\u201366.","journal-title":"Arterioscler Thromb Vasc Biol"},{"issue":"3","key":"19137_CR25","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1172\/JCI181","volume":"102","author":"GK Sukhova","year":"1998","unstructured":"Sukhova GK, Shi GP, Simon DI, Chapman HA, Libby P. Expression of the elastolytic cathepsins S and K in human atheroma and regulation of their production in smooth muscle cells. J Clin Invest. 1998;102(3):576\u201383.","journal-title":"J Clin Invest"},{"issue":"1","key":"19137_CR26","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/s40620-020-00842-w","volume":"34","author":"G Deferrari","year":"2021","unstructured":"Deferrari G, Cipriani A, La Porta E. Renal dysfunction in cardiovascular diseases and its consequences. J Nephrol. 2021;34(1):137\u201353.","journal-title":"J Nephrol"},{"issue":"1","key":"19137_CR27","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1038\/s41598-017-01042-6","volume":"7","author":"G Huang","year":"2017","unstructured":"Huang G, Xu JB, Zhang TJ, Nie XL, Li Q, Liu Y, Lv Y, Wen RL, Yang L, Zhao BY. Hyperuricemia is associated with cardiovascular diseases clustering among very elderly women - a community based study in Chengdu, China. Sci Rep. 2017;7(1):996.","journal-title":"Sci Rep"},{"key":"19137_CR28","doi-asserted-by":"crossref","unstructured":"Spencer S, Desborough R, Bhandari S. Should Cystatin C eGFR become routine clinical practice? Biomolecules 2023, 13(7).","DOI":"10.3390\/biom13071075"},{"key":"19137_CR29","doi-asserted-by":"publisher","first-page":"211","DOI":"10.2147\/CIA.S351068","volume":"17","author":"C Ren","year":"2022","unstructured":"Ren C, Su H, Tao J, Xie Y, Zhang X, Guo Q. Sarcopenia Index based on serum creatinine and cystatin C is Associated with Mortality, Nutritional Risk\/Malnutrition and Sarcopenia in older patients. Clin Interv Aging. 2022;17:211\u201321.","journal-title":"Clin Interv Aging"},{"issue":"1","key":"19137_CR30","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1186\/s12877-022-02925-8","volume":"22","author":"C Zheng","year":"2022","unstructured":"Zheng C, Wang E, Li JS, Xie K, Luo C, Ge QY, Hu LW, Shen Y. Serum creatinine\/cystatin C ratio as a screening tool for Sarcopenia and prognostic indicator for patients with esophageal cancer. BMC Geriatr. 2022;22(1):207.","journal-title":"BMC Geriatr"},{"issue":"6","key":"19137_CR31","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1038\/ki.2008.638","volume":"75","author":"LA Stevens","year":"2009","unstructured":"Stevens LA, Schmid CH, Greene T, Li L, Beck GJ, Joffe MM, Froissart M, Kusek JW, Zhang YL, Coresh J, et al. Factors other than glomerular filtration rate affect serum cystatin C levels. Kidney Int. 2009;75(6):652\u201360.","journal-title":"Kidney Int"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-024-19137-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-024-19137-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-024-19137-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T12:12:44Z","timestamp":1721736764000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-024-19137-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,23]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["19137"],"URL":"https:\/\/doi.org\/10.1186\/s12889-024-19137-x","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-3557461\/v1","asserted-by":"object"}]},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,23]]},"assertion":[{"value":"4 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 June 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2024","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 NCHS Ethics Review Board protects the rights and welfare of NHANES participants. The NHANES protocol complies with the U.S. Department of Health and Human Services Policy for the Protection of Human Research Subjects. Ethical review and approval were not required for this study, as it involved the use of publicly available data and did not qualify as human subject research in the United States.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1972"}}