{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T08:56:50Z","timestamp":1775725010397,"version":"3.50.1"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100010664","name":"Martin Rinds Stiftelse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010664","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic conditions often cluster together, forming distinct multimorbidity patterns. We aimed to explore how such patterns are associated with the risk of albuminuria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We utilized the Stockholm Creatinine Measurements (SCREAM) project, comprising 675,570 adults undergoing outpatient albuminuria testing in Stockholm, Sweden. Disease patterns were derived in adults without albuminuria at baseline, stratified by age (18\u201364, 65\u201374,\u2009\u2265\u200975 years). Associations with incident albuminuria (albumin-creatinine ratio\u2009&gt;\u200930\u00a0mg\/g) and macroalbuminuria (&gt;\u2009300\u00a0mg\/g) were examined using Cox and Fine-Gray competing risk models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified four multimorbidity patterns in younger participants (18\u201364), six in the 65\u201374 group, and seven among those aged\u2009\u2265\u200975. Across all age groups, most patterns\u2014including cardiovascular, mental health, and eye patterns\u2014were consistently associated with elevated albuminuria risk compared to those without multimorbidity. In the 65\u201374 stratum, the cardiovascular pattern had the highest risk compared to those without multimorbidity (HR 3.09: 95% CI: 2.85\u20133.34). Among those aged\u2009\u2265\u200975, almost all identified patterns showed higher risk, with those in the vascular pattern being at highest risk (HR: 2.41, 95% CI: 2.08\u20132.80). The dementia pattern showed no significant association. High-burden patterns in older participants with numerous chronic conditions (e.g., multisystem and cardiovascular patterns) were at increased risk, but this was attenuated after accounting for the competing risk of death. The 5- to 6-year cumulative incidence of albuminuria exceeded 10\u201314% in the highest-risk patterns, 5\u20139% higher than for those without multimorbidity. In interaction analyses, reduced estimated glomerular filtration rate amplified risk among younger individuals. Females generally had lower risk, except with mental health patterns in younger ages or cardiovascular multimorbidity in those 65 to 74.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Multimorbidity patterns, including those characterized by non-traditional CKD risk factors, can help identify individuals at elevated albuminuria risk. Targeted screening of these groups may enable preventive strategies to slow or prevent kidney damage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-026-04772-5","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T05:06:08Z","timestamp":1774328768000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimorbidity patterns and the subsequent risk of albuminuria: findings from the Stockholm Creatinine Measurements (SCREAM) project"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2615-226X","authenticated-orcid":false,"given":"Giorgi","family":"Beridze","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick B.","family":"Mark","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael K.","family":"Sullivan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather","family":"Walker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeru","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne-Laure","family":"Faucon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide L.","family":"Vetrano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amaia","family":"Calder\u00f3n-Larra\u00f1aga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan-Jesus","family":"Carrero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"4772_CR1","doi-asserted-by":"publisher","first-page":"101860","DOI":"10.1016\/j.eclinm.2023.101860","volume":"57","author":"SR Chowdhury","year":"2023","unstructured":"Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. eClin Med. 2023;57:101860. https:\/\/doi.org\/10.1016\/j.eclinm.2023.101860.","journal-title":"eClin Med"},{"key":"4772_CR2","doi-asserted-by":"publisher","first-page":"1649","DOI":"10.1038\/s41591-023-02420-6","volume":"29","author":"C Langenberg","year":"2023","unstructured":"Langenberg C, Hingorani AD, Whitty CJM. Biological and functional multimorbidity-from mechanisms to management. Nat Med. 2023;29:1649\u201357. https:\/\/doi.org\/10.1038\/s41591-023-02420-6.","journal-title":"Nat Med"},{"key":"4772_CR3","unstructured":"Multimorbidity: a priority for global health research. The Academy of Medical Sciences; 2018."},{"key":"4772_CR4","doi-asserted-by":"publisher","first-page":"263355652312233","DOI":"10.1177\/26335565231223350","volume":"14","author":"G Beridze","year":"2024","unstructured":"Beridze G, Abbadi A, Ars J, Remelli F, Vetrano DL, Trevisan C, et al. Patterns of multimorbidity in primary care electronic health records: a systematic review. J Multimorb Comorb. 2024;14:26335565231223350. https:\/\/doi.org\/10.1177\/26335565231223350.","journal-title":"J Multimorb Comorb"},{"key":"4772_CR5","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/j.jclinepi.2013.09.021","volume":"67","author":"A Prados-Torres","year":"2014","unstructured":"Prados-Torres A, Calder\u00f3n-Larra\u00f1aga A, Hancco-Saavedra J, Poblador-Plou B, van den Akker M. Multimorbidity patterns: a systematic review. J Clin Epidemiol. 2014;67:254\u201366. https:\/\/doi.org\/10.1016\/j.jclinepi.2013.09.021.","journal-title":"J Clin Epidemiol"},{"key":"4772_CR6","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1007\/s40520-020-01773-z","volume":"33","author":"A Marengoni","year":"2021","unstructured":"Marengoni A, Akugizibwe R, Vetrano DL, Roso-Llorach A, Onder G, Welmer A-K, et al. Patterns of multimorbidity and risk of disability in community-dwelling older persons. Aging Clin Exp Res. 2021;33:457\u201362. https:\/\/doi.org\/10.1007\/s40520-020-01773-z.","journal-title":"Aging Clin Exp Res"},{"key":"4772_CR7","doi-asserted-by":"publisher","first-page":"2183","DOI":"10.1093\/ageing\/afab138","volume":"50","author":"C Tazzeo","year":"2021","unstructured":"Tazzeo C, Rizzuto D, Calder\u00f3n-Larra\u00f1aga A, Roso-Llorach A, Marengoni A, Welmer A-K, et al. Multimorbidity patterns and risk of frailty in older community-dwelling adults: a population-based cohort study. Age Ageing. 2021;50:2183\u201391. https:\/\/doi.org\/10.1093\/ageing\/afab138.","journal-title":"Age Ageing"},{"key":"4772_CR8","doi-asserted-by":"publisher","first-page":"4001","DOI":"10.3390\/jcm9124001","volume":"9","author":"R Akugizibwe","year":"2020","unstructured":"Akugizibwe R, Calder\u00f3n-Larra\u00f1aga A, Roso-Llorach A, Onder G, Marengoni A, Zucchelli A, et al. Multimorbidity patterns and unplanned hospitalisation in a cohort of older adults. JCM. 2020;9:4001. https:\/\/doi.org\/10.3390\/jcm9124001.","journal-title":"JCM"},{"key":"4772_CR9","doi-asserted-by":"publisher","first-page":"8140","DOI":"10.24875\/SJMED.21000027","volume":"2","author":"G Beridze","year":"2022","unstructured":"Beridze G, Liborio Vetrano D, Calder\u00f3n-Larra\u00f1aga A. The interplay between kidney function and multimorbidity: a scoping review. SJMED. 2022;2:8140. https:\/\/doi.org\/10.24875\/SJMED.21000027.","journal-title":"SJMED"},{"key":"4772_CR10","doi-asserted-by":"publisher","first-page":"e030131","DOI":"10.1161\/JAHA.123.030131","volume":"13","author":"JI Barzilay","year":"2024","unstructured":"Barzilay JI, Farag YMK, Durthaler J. Albuminuria: an underappreciated risk factor for cardiovascular disease. JAHA. 2024;13:e030131. https:\/\/doi.org\/10.1161\/JAHA.123.030131.","journal-title":"JAHA"},{"key":"4772_CR11","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1681\/ASN.2018111166","volume":"30","author":"HC Looker","year":"2019","unstructured":"Looker HC, Mauer M, Saulnier P-J, Harder JL, Nair V, Boustany-Kari CM, et al. Changes in albuminuria but not GFR are associated with early changes in kidney structure in type 2 diabetes. JASN. 2019;30:1049\u201359. https:\/\/doi.org\/10.1681\/ASN.2018111166.","journal-title":"JASN"},{"key":"4772_CR12","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/j.kint.2016.09.037","volume":"91","author":"JJ Carrero","year":"2017","unstructured":"Carrero JJ, Grams ME, Sang Y, \u00c4rnl\u00f6v J, Gasparini A, Matsushita K, et al. Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality. Kidney Int. 2017;91:244\u201351. https:\/\/doi.org\/10.1016\/j.kint.2016.09.037.","journal-title":"Kidney Int"},{"key":"4772_CR13","doi-asserted-by":"publisher","first-page":"546039","DOI":"10.1155\/2012\/546039","volume":"2012","author":"JE Toblli","year":"2012","unstructured":"Toblli JE, Bevione P, Di Gennaro F, Madalena L, Cao G, Angerosa M. Understanding the mechanisms of proteinuria: therapeutic implications. Int J Nephrol. 2012;2012:546039. https:\/\/doi.org\/10.1155\/2012\/546039.","journal-title":"Int J Nephrol"},{"key":"4772_CR14","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1186\/s12877-020-01580-1","volume":"20","author":"N Villen","year":"2020","unstructured":"Villen N, Guisado-Clavero M, Fernandez-Bertolin S, Troncoso-Marino A, Foguet-Boreu Q, Amado E, et al. Multimorbidity patterns, polypharmacy and their association with liver and kidney abnormalities in people over 65 years of age: a longitudinal study. BMC Geriatr. 2020;20:206. https:\/\/doi.org\/10.1186\/s12877-020-01580-1.","journal-title":"BMC Geriatr"},{"key":"4772_CR15","doi-asserted-by":"publisher","first-page":"493","DOI":"10.3390\/jcm7120493","volume":"7","author":"W-C Lee","year":"2018","unstructured":"Lee W-C, Lee Y-T, Li L-C, Ng H-Y, Kuo W-H, Lin P-T, et al. The number of comorbidities predicts renal outcomes in patients with stage 3\u20135 chronic kidney disease. JCM. 2018;7:493. https:\/\/doi.org\/10.3390\/jcm7120493.","journal-title":"JCM"},{"key":"4772_CR16","doi-asserted-by":"publisher","first-page":"2409","DOI":"10.1093\/ckj\/sfab079","volume":"14","author":"MK Sullivan","year":"2021","unstructured":"Sullivan MK, Jani BD, Lees JS, Welsh CE, McConnachie A, Stanley B, et al. Multimorbidity and the risk of major adverse kidney events: findings from the UK Biobank cohort. Clin Kidney J. 2021;14:2409\u201319. https:\/\/doi.org\/10.1093\/ckj\/sfab079.","journal-title":"Clin Kidney J"},{"key":"4772_CR17","doi-asserted-by":"publisher","unstructured":"Beridze G, Dai L, Carrero J, Marengoni A, Vetrano DL, Calder\u00f3n\u2010Larra\u00f1aga A. Associations between multimorbidity and kidney function decline in old age: A population\u2010based cohort study. J American Geriatrics Society. 2024;:jgs.19298. https:\/\/doi.org\/10.1111\/jgs.19298.","DOI":"10.1111\/jgs.19298"},{"key":"4772_CR18","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1111\/joim.13418","volume":"291","author":"JJ Carrero","year":"2022","unstructured":"Carrero JJ, Elinder CG. The Stockholm CREAtinine measurements (SCREAM) project: fostering improvements in chronic kidney disease care. J Intern Med. 2022;291:254\u201368. https:\/\/doi.org\/10.1111\/joim.13418.","journal-title":"J Intern Med"},{"key":"4772_CR19","doi-asserted-by":"publisher","unstructured":"Calder\u00f3n-Larra\u00f1aga A, Vetrano DL, Onder G, Gimeno-Feliu LA, Coscollar-Santaliestra C, Carf\u00ed A, et al. Assessing and Measuring Chronic Multimorbidity in the Older Population: A Proposal for Its Operationalization. GERONA. 2016;:glw233. https:\/\/doi.org\/10.1093\/gerona\/glw233.","DOI":"10.1093\/gerona\/glw233"},{"key":"4772_CR20","doi-asserted-by":"publisher","first-page":"426","DOI":"10.7326\/M20-0529","volume":"173","author":"K Sumida","year":"2020","unstructured":"Sumida K, Nadkarni GN, Grams ME, Sang Y, Ballew SH, Coresh J, et al. Conversion of urine protein\u2013creatinine ratio or urine dipstick protein to urine albumin\u2013creatinine ratio for use in chronic kidney disease screening and prognosis: an individual participant\u2013based meta-analysis. Ann Intern Med. 2020;173:426\u201335. https:\/\/doi.org\/10.7326\/M20-0529.","journal-title":"Ann Intern Med"},{"key":"4772_CR21","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.kint.2023.10.018","volume":"105","author":"PE Stevens","year":"2024","unstructured":"Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, et al. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105:117\u2013314. https:\/\/doi.org\/10.1016\/j.kint.2023.10.018.","journal-title":"Kidney Int"},{"key":"4772_CR22","doi-asserted-by":"publisher","unstructured":"Nyman U, Grubb A, Larsson A, Hansson L-O, Flodin M, Nordin G, et al. The revised Lund-Malm\u00f6 GFR estimating equation outperforms MDRD and CKD-EPI across GFR, age and BMI intervals in a large Swedish population. Clinical Chemistry and Laboratory Medicine (CCLM). 2014;52. https:\/\/doi.org\/10.1515\/cclm-2013-0741.","DOI":"10.1515\/cclm-2013-0741"},{"key":"4772_CR23","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1093\/ndt\/gfad219","volume":"39","author":"EL Fu","year":"2024","unstructured":"Fu EL, Levey AS, Coresh J, Grams ME, Faucon A-L, Elinder C-G, et al. Accuracy of GFR estimating equations based on creatinine, cystatin C or both in routine care. Nephrol Dial Transplant. 2024;39:694\u2013706. https:\/\/doi.org\/10.1093\/ndt\/gfad219.","journal-title":"Nephrol Dial Transplant"},{"key":"4772_CR24","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1016\/j.jalz.2015.06.1885","volume":"11","author":"J Weuve","year":"2015","unstructured":"Weuve J, Proust\u2010Lima C, Power MC, Gross AL, Hofer SM, Thi\u00e9baut R, et al. Guidelines for reporting methodological challenges and evaluating potential bias in dementia research. Alzheimer\u2019s &amp Dementia. 2015;11:1098\u2013109. https:\/\/doi.org\/10.1016\/j.jalz.2015.06.1885.","journal-title":"Alzheimer\u2019s &amp Dementia"},{"key":"4772_CR25","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1053\/j.ajkd.2020.03.023","volume":"76","author":"M Baker","year":"2020","unstructured":"Baker M, Perazella MA. NSAIDs in CKD: are they safe? Am J Kidney Dis. 2020;76:546\u201357. https:\/\/doi.org\/10.1053\/j.ajkd.2020.03.023.","journal-title":"Am J Kidney Dis"},{"key":"4772_CR26","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1007\/s11606-010-1511-x","volume":"26","author":"LS Dalrymple","year":"2011","unstructured":"Dalrymple LS, Katz R, Kestenbaum B, Shlipak MG, Sarnak MJ, Stehman-Breen C, et al. Chronic kidney disease and the risk of end-stage renal disease versus death. J Gen Intern Med. 2011;26:379\u201385. https:\/\/doi.org\/10.1007\/s11606-010-1511-x.","journal-title":"J Gen Intern Med"},{"key":"4772_CR27","doi-asserted-by":"publisher","first-page":"22853","DOI":"10.1038\/s41598-024-71092-0","volume":"14","author":"L Klompstra","year":"2024","unstructured":"Klompstra L, L\u00f6f M, Bj\u00f6rkelund C, Hellenius M-L, Kallings LV, Orho-Melander M, et al. Co-occurrence of unhealthy lifestyle behaviours in middle-aged adults: findings from the Swedish CArdioPulmonary bioImage Study (SCAPIS). Sci Rep. 2024;14:22853. https:\/\/doi.org\/10.1038\/s41598-024-71092-0.","journal-title":"Sci Rep"},{"key":"4772_CR28","doi-asserted-by":"publisher","first-page":"1360","DOI":"10.1111\/inm.13034","volume":"31","author":"A Hallyburton","year":"2022","unstructured":"Hallyburton A. Diagnostic overshadowing: an evolutionary concept analysis on the misattribution of physical symptoms to pre\u2010existing psychological illnesses. Int J Ment Health Nurs. 2022;31:1360\u201372. https:\/\/doi.org\/10.1111\/inm.13034.","journal-title":"Int J Ment Health Nurs"},{"key":"4772_CR29","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1681\/ASN.2019030238","volume":"30","author":"P Delanaye","year":"2019","unstructured":"Delanaye P, Jager KJ, B\u00f6kenkamp A, Christensson A, Dubourg L, Eriksen BO, et al. CKD: A call for an age-adapted definition. JASN. 2019;30:1785\u2013805. https:\/\/doi.org\/10.1681\/ASN.2019030238.","journal-title":"JASN"},{"key":"4772_CR30","doi-asserted-by":"publisher","unstructured":"Ellam T, Twohig H, Khwaja A. Chronic kidney disease in elderly people: disease or disease label? BMJ. 2016;:h6559. https:\/\/doi.org\/10.1136\/bmj.h6559.","DOI":"10.1136\/bmj.h6559"},{"key":"4772_CR31","doi-asserted-by":"publisher","first-page":"1979","DOI":"10.1007\/s11255-017-1682-z","volume":"49","author":"M Raman","year":"2017","unstructured":"Raman M, Middleton RJ, Kalra PA, Green D. Estimating renal function in old people: an in-depth review. Int Urol Nephrol. 2017;49:1979\u201388. https:\/\/doi.org\/10.1007\/s11255-017-1682-z.","journal-title":"Int Urol Nephrol"},{"issue":"mar11 4","key":"4772_CR32","doi-asserted-by":"publisher","first-page":"h1059","DOI":"10.1136\/bmj.h1059","volume":"350","author":"A Marengoni","year":"2015","unstructured":"Marengoni A, Onder G. Guidelines, polypharmacy, and drug-drug interactions in patients with multimorbidity. BMJ. 2015;350(mar11 4):h1059\u2013h1059. https:\/\/doi.org\/10.1136\/bmj.h1059.","journal-title":"BMJ"}],"container-title":["BMC Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12916-026-04772-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-026-04772-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-026-04772-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T08:02:11Z","timestamp":1775721731000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12916-026-04772-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,24]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4772"],"URL":"https:\/\/doi.org\/10.1186\/s12916-026-04772-5","relation":{},"ISSN":["1741-7015"],"issn-type":[{"value":"1741-7015","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,24]]},"assertion":[{"value":"11 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2026","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 study was approved by the Regional Ethical Review Board in Stockholm, Sweden (reference: 2017\/793\u201331). The need for informed consent was waived due to the register-based nature of the study. All data were deidentified by the Swedish Board of Health and Welfare.","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 no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"213"}}