{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T18:32:53Z","timestamp":1767033173337,"version":"3.48.0"},"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Statin prescribing patterns in osteoporosis patients remain uncharacterized despite cardiovascular disease being a leading cause of mortality in this population. This study examined temporal trends and demographic variations in statin prescription rates among osteoporosis patients in the UK. This research is a retrospective cohort study utilizing the IQVIA Medical Research Data (IMRD) spanning 2005\u20132019. Patients\u2019 diagnosis of osteoporosis and corresponding statin prescription data were extracted. Prevalence and incidence of statin prescription were calculated, followed by age-stratified and gender-stratified trends analysis using joinpoint regression to calculate the average percent change (APC), annual average percent change (AAPC), and identify significant temporal shifts. Among 157,483 identified osteoporosis patients, statin prescribing trends demonstrated significant reductions in both prescription prevalence (AAPC: -1.03%, p\u2009=\u20090.005) and incidence rate (AAPC:-1.82%, p\u2009&lt;\u20090.001). Gender-based analysis revealed higher prescription rates and more pronounced declines in male patients (prevalence AAPC:2.7% vs female -0.8%), resulting in prescription rate convergence by study end. Age stratified findings showed the 70\u201379 years age group maintained the highest initial prevalence but experienced the steepest declines. A notable breakpoint occurred in 2018 within the 50\u201359 age cohort, which may be a result of stricter ACC\/AHA cholesterol guidelines requiring enhanced risk-based criteria for primary and secondary prevention. The prescription peaks in 2006 and 2014 likely coincided with NICE guideline modifications. Despite these guideline expansions encouraging broader statin use, sensitivity analysis of cumulative defined daily dose revealed persistently high discontinuation rates in osteoporosis patients. These patterns indicate substantial gaps in cardiovascular protection for this vulnerable population. Declining statin prescription trends among osteoporosis patients, particularly among elderly males, appear to reflect an evolution in clinical practices toward risk-benefit assessment. These findings highlight the need for treatment guideline advancement that addresses both appropriate statin initiation and strategies to improve long-term adherence in patients with multimorbidity.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005656","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T18:28:21Z","timestamp":1767032901000},"page":"e0005656","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in statin prescription among osteoporosis patients: A retrospective cohort study using UK primary care data"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5851-8192","authenticated-orcid":true,"given":"Ingrid Mei-Fung","family":"Wong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0736-4726","authenticated-orcid":true,"given":"Philip Chun-Ming","family":"Au","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4360-2699","authenticated-orcid":true,"given":"Noel Cassandra","family":"Yue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4454-8580","authenticated-orcid":true,"given":"Jonathan Ka-Long","family":"Mak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaowen","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chor-Wing","family":"Sing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn Choon-Beng","family":"Tan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ching-Lung","family":"Cheung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerard","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,29]]},"reference":[{"key":"pgph.0005656.ref001","volume-title":"Epidemiology, Burden, and Treatment of Osteoporosis in the United Kingdom","author":"I International Osteoporosis Foundation","year":"2021"},{"issue":"1","key":"pgph.0005656.ref002","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1007\/s11657-013-0136-1","article-title":"Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA)","volume":"8","author":"E Hernlund","year":"2013","journal-title":"Arch Osteoporos"},{"issue":"10169","key":"pgph.0005656.ref003","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/S0140-6736(18)32112-3","article-title":"Osteoporosis","volume":"393","author":"JE Compston","year":"2019","journal-title":"The Lancet"},{"key":"pgph.0005656.ref004","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1038\/bonekey.2012.144","article-title":"Association between cardiovascular diseases and osteoporosis-reappraisal","volume":"1","author":"P Szulc","year":"2012","journal-title":"Bonekey Rep"},{"issue":"1","key":"pgph.0005656.ref005","first-page":"19","article-title":"The link between osteoporosis and cardiovascular disease","volume":"5","author":"GN Farhat","year":"2008","journal-title":"Clin Cases Miner Bone Metab"},{"issue":"2","key":"pgph.0005656.ref006","doi-asserted-by":"crossref","first-page":"109","DOI":"10.2188\/jea.JE20120071","article-title":"Risk of major osteoporotic fracture after cardiovascular disease: a population-based cohort study in Taiwan","volume":"23","author":"S-W Lai","year":"2013","journal-title":"J Epidemiol"},{"issue":"1","key":"pgph.0005656.ref007","doi-asserted-by":"crossref","first-page":"4353","DOI":"10.1038\/s41467-024-48713-3","article-title":"Unveiling unique clinical phenotypes of hip fracture patients and the temporal association with cardiovascular events","volume":"15","author":"WWQ Hsu","year":"2024","journal-title":"Nat Commun"},{"issue":"2","key":"pgph.0005656.ref008","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1007\/s11033-022-08088-4","article-title":"Osteoporosis and cardiovascular disease: a review","volume":"50","author":"TA Azeez","year":"2023","journal-title":"Mol Biol Rep"},{"key":"pgph.0005656.ref009","doi-asserted-by":"crossref","first-page":"165","DOI":"10.3389\/fendo.2015.00165","article-title":"High cholesterol deteriorates bone health: new insights into molecular mechanisms","volume":"6","author":"CC Mandal","year":"2015","journal-title":"Front Endocrinol (Lausanne)"},{"key":"pgph.0005656.ref010","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.biocel.2016.05.015","article-title":"The role of the wnt\/\u03b2-catenin signaling pathway in formation and maintenance of bone and teeth","volume":"77","author":"P Duan","year":"2016","journal-title":"Int J Biochem Cell Biol"},{"key":"pgph.0005656.ref011","doi-asserted-by":"crossref","first-page":"8758","DOI":"10.12659\/MSM.912309","article-title":"Treatment of osteoporosis, with a focus on 2 monoclonal antibodies","volume":"24","author":"B Chang","year":"2018","journal-title":"Med Sci Monit"},{"issue":"25","key":"pgph.0005656.ref012","article-title":"2018 AHA\/ACC\/AACVPR\/AAPA\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"139","author":"SM Grundy","year":"2019","journal-title":"Circulation"},{"issue":"4","key":"pgph.0005656.ref013","doi-asserted-by":"crossref","DOI":"10.3390\/ijms25042378","article-title":"Statins - their role in bone tissue metabolism and local applications with different carriers","volume":"25","author":"MM Granat","year":"2024","journal-title":"Int J Mol Sci"},{"issue":"19","key":"pgph.0005656.ref014","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000038122","article-title":"Comparison of the pleiotropic effect of atorvastatin and rosuvastatin on postmenopausal changes in bone turnover: a randomized comparative study","volume":"103","author":"A Braszak-Cymerman","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"pgph.0005656.ref015","doi-asserted-by":"crossref","first-page":"111697","DOI":"10.1016\/j.biopha.2021.111697","article-title":"Pitavastatin prevents ovariectomy-induced osteoporosis by regulating osteoclastic resorption and osteoblastic formation","volume":"139","author":"Y-H Cheon","year":"2021","journal-title":"Biomed Pharmacother"},{"issue":"11","key":"pgph.0005656.ref016","doi-asserted-by":"crossref","first-page":"1927","DOI":"10.1007\/s00198-023-06879-4","article-title":"Age- and dose-dependent effect of statin use on the risk of osteoporotic fracture in older adults","volume":"34","author":"DH Seo","year":"2023","journal-title":"Osteoporos Int"},{"issue":"1","key":"pgph.0005656.ref017","doi-asserted-by":"crossref","first-page":"30825","DOI":"10.1038\/s41598-024-81628-z","article-title":"Association of higher potency statin use with risk of osteoporosis and fractures in patients with stroke in a Korean nationwide cohort study","volume":"14","author":"JS Jeong","year":"2024","journal-title":"Sci Rep"},{"issue":"9","key":"pgph.0005656.ref018","doi-asserted-by":"crossref","first-page":"3439","DOI":"10.1210\/jc.2018-00652","article-title":"Statin use is associated with decreased osteoporosis and fracture risks in stroke patients","volume":"103","author":"S-M Lin","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"pgph.0005656.ref019","doi-asserted-by":"crossref","first-page":"123","DOI":"10.2147\/CLEP.S104258","article-title":"Time trends in the prescription of statins for the primary prevention of cardiovascular disease in the United Kingdom: a cohort study using The Health Improvement Network primary care data","volume":"8","author":"AG O\u2019Keeffe","year":"2016","journal-title":"Clin Epidemiol"},{"issue":"3","key":"pgph.0005656.ref020","article-title":"Initiation rates of statin therapy for the primary prevention of cardiovascular disease: an assessment of differences between countries of the UK and between regions within England","volume":"5","author":"AG O\u2019Keeffe","year":"2015","journal-title":"BMJ Open"},{"key":"pgph.0005656.ref021","doi-asserted-by":"crossref","unstructured":"Muzambi R, Bhaskaran K, Strongman H, Staa T, Smeeth L, Herrett E. Trends and inequalities in statin use for the primary and secondary prevention of cardiovascular disease between 2009 and 2021 in England. 2024.","DOI":"10.1101\/2024.11.22.24317782"},{"issue":"10","key":"pgph.0005656.ref022","doi-asserted-by":"crossref","first-page":"2000","DOI":"10.1093\/aje\/kwab031","article-title":"Prediction of Cardiovascular Disease Risk Accounting for Future Initiation of Statin Treatment","volume":"190","author":"Z Xu","year":"2021","journal-title":"Am J Epidemiol"},{"issue":"10","key":"pgph.0005656.ref023","doi-asserted-by":"crossref","DOI":"10.1016\/j.jacc.2019.03.009","article-title":"2019 ACC\/AHA guideline on the primary prevention of cardiovascular disease","volume":"74","author":"DK Arnett","year":"2019","journal-title":"JACC"},{"issue":"2","key":"pgph.0005656.ref024","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s11892-015-0703-5","article-title":"The 2013 ACC\/AHA Cholesterol Treatment Guidelines: applicability to patients with diabetes","volume":"16","author":"B Ziaeian","year":"2016","journal-title":"Curr Diab Rep"},{"key":"pgph.0005656.ref025","volume-title":"IQVIA Medical Research Data. NHS","author":"NHR Authority","year":"2018"},{"key":"pgph.0005656.ref026","volume-title":"IQVIA Medical Research Data. In: IMRD incorporates data from THIN ACDRmtTiitbdotdalbI","author":"IQVIA","year":"2018"},{"issue":"3","key":"pgph.0005656.ref027","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/0895-4356(94)00137-F","article-title":"The VAMP Research multi-purpose database in the U.K","volume":"48","author":"Y Lis","year":"1995","journal-title":"J Clin Epidemiol"},{"issue":"7000","key":"pgph.0005656.ref028","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1136\/bmj.311.7000.313","article-title":"Use of Read codes in development of a standard data set","volume":"311","author":"N Smith","year":"1995","journal-title":"BMJ"},{"issue":"4","key":"pgph.0005656.ref029","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1002\/pds.1335","article-title":"Validation studies of the health improvement network (THIN) database for pharmacoepidemiology research","volume":"16","author":"JD Lewis","year":"2007","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"3","key":"pgph.0005656.ref030","first-page":"602","article-title":"Validity of The Health Improvement Network (THIN) for the study of psoriasis","volume":"164","author":"NM Seminara","year":"2011","journal-title":"Br J Dermatol"},{"issue":"4","key":"pgph.0005656.ref031","first-page":"251","article-title":"Generalisability of The Health Improvement Network (THIN) database: demographics, chronic disease prevalence and mortality rates","volume":"19","author":"BT Blak","year":"2011","journal-title":"Inform Prim Care"},{"issue":"1","key":"pgph.0005656.ref032","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s11657-020-0706-y","article-title":"Fragility fractures in Europe: burden, management and opportunities","volume":"15","author":"F Borgstr\u00f6m","year":"2020","journal-title":"Arch Osteoporos"},{"key":"pgph.0005656.ref033","volume-title":"Statins for the prevention of cardiovascular events: TA94","author":"(NICE) NIfHaCE","year":"2006"},{"key":"pgph.0005656.ref034","article-title":"National Institute for Health and Clinical Excellence: Guidance","volume-title":"Lipid Modification: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease","author":"National Clinical Guideline C","year":"2014"},{"key":"pgph.0005656.ref035","article-title":"Understanding the causes and consequences of low statin adherence: evidence from UK Biobank primary care data","author":"D T\u00fcrkmen","year":"2025","journal-title":"medRxiv"},{"issue":"3","key":"pgph.0005656.ref036","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.jacl.2012.03.003","article-title":"Understanding statin use in America and Gaps in Patient Education (USAGE): an internet-based survey of 10,138 current and former statin users","volume":"6","author":"JD Cohen","year":"2012","journal-title":"J Clin Lipidol"},{"issue":"6","key":"pgph.0005656.ref037","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1080\/14779072.2023.2215982","article-title":"Statin associated muscle symptoms (SAMS): strategies for prevention, assessment and management","volume":"21","author":"I Iatan","year":"2023","journal-title":"Expert Rev Cardiovasc Ther"},{"issue":"2","key":"pgph.0005656.ref038","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s10557-017-6723-4","article-title":"The Statin-Associated Muscle Symptom Clinical Index (SAMS-CI): revision for clinical use, content validation, and inter-rater reliability","volume":"31","author":"RS Rosenson","year":"2017","journal-title":"Cardiovasc Drugs Ther"},{"issue":"2","key":"pgph.0005656.ref039","first-page":"137","article-title":"Relationship between statin-associated muscle symptoms, serum vitamin d and low-density lipoprotein cholesterol - a cross-sectional study","volume":"16","author":"H Kaur","year":"2020","journal-title":"Eur Endocrinol"},{"key":"pgph.0005656.ref040","doi-asserted-by":"crossref","first-page":"104201","DOI":"10.1016\/j.phrs.2019.03.010","article-title":"Mechanisms of statin-associated skeletal muscle-associated symptoms","volume":"154","author":"J Bouitbir","year":"2020","journal-title":"Pharmacol Res"},{"issue":"20","key":"pgph.0005656.ref041","doi-asserted-by":"crossref","first-page":"2395","DOI":"10.1016\/j.jacc.2016.02.071","article-title":"Statin-associated side effects","volume":"67","author":"PD Thompson","year":"2016","journal-title":"J Am Coll Cardiol"},{"issue":"8","key":"pgph.0005656.ref042","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/s40266-019-00673-w","article-title":"Statins for primary prevention in those aged 70 years and older: a critical review of recent cholesterol guidelines","volume":"36","author":"CE Hawley","year":"2019","journal-title":"Drugs Aging"},{"issue":"6","key":"pgph.0005656.ref043","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1001\/jama.297.6.611","article-title":"Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score","volume":"297","author":"PM Ridker","year":"2007","journal-title":"JAMA"},{"issue":"9","key":"pgph.0005656.ref044","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1001\/archinternmed.2009.50","article-title":"Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women\u2019s Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project","volume":"169","author":"M Gulati","year":"2009","journal-title":"Arch Intern Med"},{"key":"pgph.0005656.ref045","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.thromres.2019.10.005","article-title":"Effect of hormone replacement therapy on atherogenic lipid profile in postmenopausal women","volume":"184","author":"I Gregersen","year":"2019","journal-title":"Thromb Res"},{"issue":"5","key":"pgph.0005656.ref046","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1089\/jwh.2011.3220","article-title":"Sex-specific association of age with carotid artery distensibility: multi-ethnic study of atherosclerosis","volume":"21","author":"D Vaidya","year":"2012","journal-title":"J Womens Health (Larchmt)"},{"issue":"10","key":"pgph.0005656.ref047","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1097\/gme.0b013e3182517bd0","article-title":"Early menopause predicts future coronary heart disease and stroke: the Multi-Ethnic Study of Atherosclerosis","volume":"19","author":"M Wellons","year":"2012","journal-title":"Menopause"},{"issue":"9917","key":"pgph.0005656.ref048","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1016\/S0140-6736(13)62348-X","article-title":"Statins, risk assessment, and the new American prevention guidelines","volume":"383","author":"DM Lloyd-Jones","year":"2014","journal-title":"Lancet"},{"issue":"2","key":"pgph.0005656.ref049","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1161\/CIRCULATIONAHA.113.007648","article-title":"Comment on the reports of over-estimation of ASCVD risk using the 2013 AHA\/ACC risk equation","volume":"129","author":"P Muntner","year":"2014","journal-title":"Circulation"},{"key":"pgph.0005656.ref050","author":"Cardiology TAHAatACo","year":"2018"},{"issue":"1","key":"pgph.0005656.ref051","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s11657-022-01128-3","article-title":"The association between coronary artery disease and osteoporosis: a population-based longitudinal study in Taiwan","volume":"17","author":"D-K Syu","year":"2022","journal-title":"Arch Osteoporos"},{"key":"pgph.0005656.ref052","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ejim.2016.05.022","article-title":"Polypharmacy and specific comorbidities in university primary care settings","volume":"35","author":"CE Aubert","year":"2016","journal-title":"Eur J Intern Med"},{"key":"pgph.0005656.ref053","first-page":"261","article-title":"Pleiotropic effects of the HMG-CoA reductase inhibitors","volume":"4","author":"CG Mihos","year":"2011","journal-title":"Int J Gen Med"},{"issue":"1","key":"pgph.0005656.ref054","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/nsr\/nwu028","article-title":"Novel applications of statins for bone regeneration","volume":"2","author":"SR Shah","year":"2015","journal-title":"Natl Sci Rev"},{"key":"pgph.0005656.ref055","doi-asserted-by":"crossref","first-page":"6747469","DOI":"10.1155\/2022\/6747469","article-title":"Meta-analysis of the efficacy and safety of alendronate combined with atorvastatin in the treatment of osteoporosis in diabetes mellitus","volume":"2022","author":"Z Xiong","year":"2022","journal-title":"Biomed Res Int"},{"issue":"6","key":"pgph.0005656.ref056","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1211\/jpp.61.06.0011","article-title":"Synergistic action of statins and nitrogen-containing bisphosphonates in the development of rhabdomyolysis in L6 rat skeletal myoblasts","volume":"61","author":"T Nishiguchi","year":"2009","journal-title":"J Pharm Pharmacol"},{"key":"pgph.0005656.ref057","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.2147\/TCRM.S138000","article-title":"A comprehensive overview on osteoporosis and its risk factors","volume":"14","author":"F Pouresmaeili","year":"2018","journal-title":"Ther Clin Risk Manag"},{"issue":"2","key":"pgph.0005656.ref058","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s40264-012-0009-3","article-title":"An evaluation of the THIN database in the OMOP Common Data Model for active drug safety surveillance","volume":"36","author":"X Zhou","year":"2013","journal-title":"Drug Saf"},{"issue":"9","key":"pgph.0005656.ref059","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1002\/pds.2191","article-title":"Temporal and within practice variability in the health improvement network","volume":"20","author":"K Haynes","year":"2011","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"5","key":"pgph.0005656.ref060","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-034573","article-title":"Trends in oral anticoagulant prescribing in individuals with type 2 diabetes mellitus: a population-based study in the UK","volume":"10","author":"H Alwafi","year":"2020","journal-title":"BMJ Open"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005656","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T18:28:30Z","timestamp":1767032910000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005656"}},"subtitle":[],"editor":[{"given":"Arindam","family":"Nandi","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,29]]},"references-count":60,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0005656","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,29]]}}}