{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T16:11:00Z","timestamp":1787587860391,"version":"build-2736575974"},"reference-count":62,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP 21K10938"],"award-info":[{"award-number":["JP 21K10938"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec040\">\n<jats:title>Background<\/jats:title>\n<jats:p>Hypertensive disorders of pregnancy (HDP) significantly increase the risk of developing hypertension and cardiovascular disease (CVD) later in life and are a major cause of maternal mortality. However, little is known about the nationwide, long-term, all-inclusive status of HDP.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec041\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To estimate the incidence of HDP from 2011 to 2019 in Hokkaido, Japan, with a focus on age groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec042\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Using National Database (NDB) insurance medical data, a retrospective analysis was conducted. Due to the absence of direct pregnancy data, birth numbers were used as a surrogate for the number of pregnant women to calculate the incidence of HDP.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec043\">\n<jats:title>Results<\/jats:title>\n<jats:p>The average incidence rate of HDP over 9 years was 6.37%. The incidence rate was lowest among women aged 25\u201329 years, at 5.58% (95% confidence interval [CI]: 5.43\u20135.73), and increased with age, peaking at 10.58% (95% CI: 10.10\u201311.09) among women over 40 years. Notably, the incidence rate for women under 20 years of age was 6.70% (95% CI: 5.97\u20137.51), which was higher than that for women in their 20s. A mean annual increase of 0.25% in age-adjusted incidence was observed during this period, which was statistically significant (R\u00b2 =\u2009 0.87, p &lt;\u2009 0.01).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec044\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This study reveals that the risk of developing HDP is associated with both older childbearing and younger pregnancies and follows a J-curve, suggesting that factors other than maternal aging also contribute to the increased incidence of HDP and that further research on risk factors for HDP, which is on the rise worldwide, is urgently needed.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0319177","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T18:38:21Z","timestamp":1740076701000},"page":"e0319177","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Maternal age and the rising incidence of hypertensive disorders of pregnancy: A comprehensive analysis of national claims data from Japan"],"prefix":"10.1371","volume":"20","author":[{"given":"Naomi","family":"Maeda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8165-5855","authenticated-orcid":true,"given":"Masayuki","family":"Koyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shintaro","family":"Takatsuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Oyatani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuaki","family":"Himuro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7110-980X","authenticated-orcid":true,"given":"Tasuku","family":"Mariya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshika","family":"Kuno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiro","family":"Hinotsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Saito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirofumi","family":"Ohnishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"issue":"6","key":"pone.0319177.ref001","doi-asserted-by":"crossref","first-page":"e323","DOI":"10.1016\/S2214-109X(14)70227-X","article-title":"Global causes of maternal death: a WHO systematic analysis","volume":"2","author":"L Say","year":"2014","journal-title":"Lancet Glob Health"},{"key":"pone.0319177.ref002","doi-asserted-by":"crossref","first-page":"e071653","DOI":"10.1136\/bmj-2022-071653","article-title":"Hypertensive disorders of pregnancy","volume":"381","author":"P Wu","year":"2023","journal-title":"BMJ"},{"issue":"8","key":"pone.0319177.ref003","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1038\/s41440-022-00965-6","article-title":"Hypertensive disorders of pregnancy: definition, management, and out-of-office blood pressure measurement","volume":"45","author":"H Metoki","year":"2022","journal-title":"Hypertens Res"},{"issue":"3","key":"pone.0319177.ref004","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1111\/1471-0528.16545","article-title":"Incidence of postpartum hypertension within 2 years of a pregnancy complicated by pre-eclampsia: a systematic review and meta-analysis","volume":"128","author":"V Giorgione","year":"2021","journal-title":"BJOG"},{"key":"pone.0319177.ref005","doi-asserted-by":"crossref","first-page":"j3078","DOI":"10.1136\/bmj.j3078","article-title":"Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study","volume":"358","author":"I Behrens","year":"2017","journal-title":"BMJ"},{"issue":"11","key":"pone.0319177.ref006","doi-asserted-by":"crossref","first-page":"4052","DOI":"10.3390\/ijerph17114052","article-title":"Gestational hypertension as risk factor of hypertension in middle-aged and older women","volume":"17","author":"M Watanabe","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"11","key":"pone.0319177.ref007","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1038\/s41440-020-0463-8","article-title":"Hypertensive disorders of pregnancy, obesity, and hypertension in later life by age group: a cross-sectional analysis","volume":"43","author":"M Wagata","year":"2020","journal-title":"Hypertens Res"},{"issue":"30","key":"pone.0319177.ref008","doi-asserted-by":"crossref","first-page":"e29646","DOI":"10.1097\/MD.0000000000029646","article-title":"Risk of future cardiovascular diseases in different years postpartum after hypertensive disorders of pregnancy: a systematic review and meta-analysis","volume":"101","author":"J Sukmanee","year":"2022","journal-title":"Medicine (Baltim)"},{"issue":"10","key":"pone.0319177.ref009","doi-asserted-by":"crossref","first-page":"e008337","DOI":"10.1161\/JAHA.117.008337","article-title":"Association between gestational hypertension and risk of cardiovascular disease among 617,589 Norwegian women","volume":"7","author":"HKR Riise","year":"2018","journal-title":"J Am Heart Assoc"},{"issue":"4","key":"pone.0319177.ref010","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1161\/HYPERTENSIONAHA.117.09246","article-title":"All hypertensive disorders of pregnancy increase the risk of future cardiovascular disease","volume":"70","author":"J Tooher","year":"2017","journal-title":"Hypertension"},{"issue":"19","key":"pone.0319177.ref011","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1016\/j.jacc.2022.03.335","article-title":"Cardiovascular risk factors mediate the long-term maternal risk associated with hypertensive disorders of pregnancy","volume":"79","author":"JJ Stuart","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"8","key":"pone.0319177.ref012","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1161\/CIRCULATIONAHA.118.036748","article-title":"Cardiovascular disease-related morbidity and mortality in women with a history of pregnancy complications","volume":"139","author":"SM Grandi","year":"2019","journal-title":"Circulation"},{"issue":"6","key":"pone.0319177.ref013","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1097\/GME.0000000000000361","article-title":"Pregnancy-induced hypertension is associated with an increase in the prevalence of cardiovascular disease risk factors in Japanese women","volume":"22","author":"K Watanabe","year":"2015","journal-title":"Menopause"},{"issue":"4","key":"pone.0319177.ref014","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.bpobgyn.2011.01.006","article-title":"Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy","volume":"25","author":"JA Hutcheon","year":"2011","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"issue":"3","key":"pone.0319177.ref015","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1038\/hr.2016.126","article-title":"Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis","volume":"40","author":"M Umesawa","year":"2017","journal-title":"Hypertens Res"},{"issue":"1","key":"pone.0319177.ref016","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-021-03809-2","article-title":"Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population\u2010based study","volume":"21","author":"W Wang","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"pone.0319177.ref017","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1186\/s12884-019-2400-x","article-title":"Maternal age and the risk of adverse pregnancy outcomes: a retrospective cohort study","volume":"19","author":"AP Londero","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"issue":"6","key":"pone.0319177.ref018","doi-asserted-by":"crossref","first-page":"e100180","DOI":"10.1371\/journal.pone.0100180","article-title":"The 2011 survey on hypertensive disorders of pregnancy (HDP) in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes","volume":"9","author":"C Ye","year":"2014","journal-title":"PLoS One"},{"issue":"1","key":"pone.0319177.ref019","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-017-1540-0","article-title":"Association between very advanced maternal age and adverse pregnancy outcomes: a cross sectional Japanese study","volume":"17","author":"K Ogawa","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0319177.ref020","author":"Statistics Bureau of Japan","year":"2021"},{"key":"pone.0319177.ref021","author":"S Fulmer","year":"2024"},{"issue":"1","key":"pone.0319177.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.31662\/jmaj.2018-0016","article-title":"Health policy in Japan \u2013 current situation and future challenges","volume":"2","author":"S Matsuda","year":"2019","journal-title":"JMA J"},{"key":"pone.0319177.ref023","author":"Japan Ministry of Health Labour, and Welfare"},{"key":"pone.0319177.ref024","author":"Japan Ministry of Health Labour, and Welfare"},{"issue":"4","key":"pone.0319177.ref025","doi-asserted-by":"crossref","first-page":"e0251056","DOI":"10.1371\/journal.pone.0251056","article-title":"Association between number of teeth and Alzheimer\u2019s disease using the National Database of Health Insurance Claims and Specific Health Checkups of Japan","volume":"16","author":"M Tsuneishi","year":"2021","journal-title":"PLoS One"},{"key":"pone.0319177.ref026","volume-title":"Guidelines for the use of the national database of health insurance claims and specific health checkups of Japan"},{"key":"pone.0319177.ref027","first-page":"280008","article-title":"National database of health insurance claims and specific health checkups of Japan (NDB): outline and patient-matching technique","volume":"1","author":"S Kubo","year":"2018","journal-title":"BioRxiv"},{"issue":"12","key":"pone.0319177.ref028","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1136\/bjophthalmol-2021-319403","article-title":"Incidence of central serous chorioretinopathy (2011\u20132018): a nationwide population-based cohort study of Japan","volume":"106","author":"A Kido","year":"2022","journal-title":"Br J Ophthalmol"},{"issue":"6","key":"pone.0319177.ref029","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1111\/jog.14772","article-title":"Cesarean delivery rates for overall and multiple pregnancies in Japan: a descriptive study using nationwide health insurance claims data","volume":"47","author":"E Maeda","year":"2021","journal-title":"J Obstet Gynaecol Res"},{"issue":"4","key":"pone.0319177.ref030","doi-asserted-by":"crossref","first-page":"186","DOI":"10.2188\/jea.JE20210074","article-title":"Epidemiology of developmental dysplasia of the hip: analysis of Japanese national database","volume":"33","author":"H Den","year":"2021","journal-title":"J Epidemiol"},{"issue":"2","key":"pone.0319177.ref031","doi-asserted-by":"crossref","first-page":"33","DOI":"10.14390\/jsshp.HRP2018-014","article-title":"Outline of the new definition and classification of \u201cHypertensive Disorders of Pregnancy (HDP)\u201d; a revised JSSHP statement of 2005","volume":"6","author":"K Watanabe","year":"2018","journal-title":"Hypertens Res Pregnancy"},{"issue":"1","key":"pone.0319177.ref032","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14390\/jsshp.HRP2019-010","article-title":"New definition and classification of \u201cHypertensive Disorders of Pregnancy (HDP)","volume":"7","author":"S Makino","year":"2019","journal-title":"Hypertens Res Pregnancy"},{"key":"pone.0319177.ref033","author":"The Japan Society of Obstetrics and Gynecology"},{"issue":"7","key":"pone.0319177.ref034","doi-asserted-by":"crossref","first-page":"3342","DOI":"10.3390\/ijerph18073342","article-title":"Hypertensive Disorders during Pregnancy (HDP), maternal characteristics, and birth outcomes among Japanese women: a Hokkaido study","volume":"18","author":"K Poudel","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"18","key":"pone.0319177.ref035","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1016\/j.jacc.2020.03.028","article-title":"Incidence and long-term outcomes of hypertensive disorders of pregnancy","volume":"75","author":"VD Garovic","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"pone.0319177.ref036","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.preghy.2021.02.005","article-title":"Hypertension in pregnancy: prevalence, risk factors and outcomes for women birthing in Ireland","volume":"24","author":"L Corrigan","year":"2021","journal-title":"Pregnancy Hypertens"},{"issue":"6","key":"pone.0319177.ref037","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1007\/s10995-014-1624-7","article-title":"Maternal age and risk of labor and delivery complications","volume":"19","author":"PA Cavazos-Rehg","year":"2015","journal-title":"Matern Child Health J"},{"issue":"Suppl 1","key":"pone.0319177.ref038","first-page":"40","article-title":"Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study","volume":"121","author":"WHO Multicountry Survey on Maternal Newborn Health Research Network","year":"2014","journal-title":"BJOG"},{"issue":"Suppl 1","key":"pone.0319177.ref039","first-page":"14","article-title":"Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health","volume":"121","author":"WHO Multicountry Survey on Maternal and Newborn Health Research Network","year":"2014","journal-title":"BJOG"},{"key":"pone.0319177.ref040","unstructured":"Statistics Bureau of Japan. Number, percentage, and fertility rate of live births by mother\u2019s age (5-year age group) by year [Data file]. (in Japanese) Accessed 18 Mar 2024."},{"issue":"2","key":"pone.0319177.ref041","first-page":"194","article-title":"The analysis of social background and perinatal prognosis of teen pregnancy in Japan (in Japanese)","volume":"59","author":"M Akazawa","year":"2023","journal-title":"J Jpn Soc Perinat Neonatal Med"},{"issue":"4","key":"pone.0319177.ref042","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1038\/s41440-019-0206-x","article-title":"Higher prevalence of hypertensive disorders of pregnancy in women who smoke: the Japan environment and children\u2019s study","volume":"42","author":"Japan Environment & Children\u2019s Study Group","year":"2019","journal-title":"Hypertens Res"},{"issue":"10","key":"pone.0319177.ref043","doi-asserted-by":"crossref","first-page":"498","DOI":"10.2188\/jea.JE20220076","article-title":"Association between smoking and hypertension in pregnancy among Japanese Women: a meta-analysis of birth cohort studies in the Japan Birth Cohort Consortium (JBiCC) and JECS","volume":"33","author":"N Morisaki","year":"2023","journal-title":"J Epidemiol"},{"issue":"11","key":"pone.0319177.ref044","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1080\/14767058.2017.1421928","article-title":"Clinical significance of pregnancy in adolescence in Japan","volume":"32","author":"S Suzuki","year":"2019","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"2","key":"pone.0319177.ref045","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.jpag.2018.10.009","article-title":"Risky health behaviors of teenage mothers and infant outcomes in the Japan environment and children\u2019s study: a nationwide cohort study","volume":"32","author":"Japan Environment and Children's Study Group","year":"2019","journal-title":"J Pediatr Adolesc Gynecol"},{"key":"pone.0319177.ref046","author":"Hokkaido Health and Welfare Department"},{"issue":"7","key":"pone.0319177.ref047","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1161\/CIRCRESAHA.118.313276","article-title":"Preeclampsia","volume":"124","author":"S Rana","year":"2019","journal-title":"Circ Res"},{"issue":"2","key":"pone.0319177.ref048","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/MNH.0000000000000105","article-title":"Pathogenesis of preeclampsia","volume":"24","author":"M Sircar","year":"2015","journal-title":"Curr Opin Nephrol Hypertens"},{"issue":"5","key":"pone.0319177.ref049","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.tjog.2017.08.004","article-title":"Preeclampsia: a review of the pathogenesis and possible management strategies based on its pathophysiological derangements","volume":"56","author":"AAF El-Sayed","year":"2017","journal-title":"Taiwan J Obstet Gynecol"},{"issue":"2","key":"pone.0319177.ref050","first-page":"99","article-title":"Non-obstetric complications in preeclampsia","volume":"18","author":"K Pankiewicz","year":"2019","journal-title":"Prz Menopauzalny"},{"issue":"6","key":"pone.0319177.ref051","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.2215\/CJN.12081115","article-title":"Preeclampsia: updates in pathogenesis, definitions, and guidelines","volume":"11","author":"E Phipps","year":"2016","journal-title":"Clin J Am Soc Nephrol"},{"issue":"12","key":"pone.0319177.ref052","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/j.placenta.2013.09.017","article-title":"Advanced glycation end products as an upstream molecule triggers ROS-induced sFlt-1 production in extravillous trophoblasts: a novel bridge between oxidative stress and preeclampsia","volume":"34","author":"QT Huang","year":"2013","journal-title":"Placenta"},{"issue":"1","key":"pone.0319177.ref053","doi-asserted-by":"crossref","first-page":"2217452","DOI":"10.1080\/10641955.2023.2217452","article-title":"Prevalence of hypertensive disorders of pregnancy at or beyond 39 weeks gestational age and associated maternal complications","volume":"42","author":"E Fronek","year":"2023","journal-title":"Hypertens Pregnancy"},{"issue":"2","key":"pone.0319177.ref054","doi-asserted-by":"crossref","first-page":"e023791","DOI":"10.1161\/JAHA.121.023791","article-title":"Trends in the incidence of new\u2010onset hypertensive disorders of pregnancy among rural and urban areas in the United States, 2007 to 2019","volume":"11","author":"NA Cameron","year":"2022","journal-title":"J Am Heart Assoc"},{"issue":"1","key":"pone.0319177.ref055","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.fertnstert.2015.09.007","article-title":"Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies","volume":"105","author":"J Qin","year":"2016","journal-title":"Fertil Steril"},{"issue":"16","key":"pone.0319177.ref056","doi-asserted-by":"crossref","first-page":"2826","DOI":"10.1080\/14767058.2018.1560406","article-title":"Risk of preeclampsia following assisted reproductive technology: systematic review and meta-analysis of 72 cohort studies","volume":"33","author":"R Omani-Samani","year":"2020","journal-title":"J Matern Fetal Neonatal Med"},{"key":"pone.0319177.ref057","article-title":"ART Data Book","author":"The Japan Society of Obstetrics and Gynecology"},{"key":"pone.0319177.ref058","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.maturitas.2016.02.012","article-title":"Blood pressure during pregnancy is a useful predictive maker for hypertension and dyslipidemia later in life, a population-based, cross-sectional study","volume":"87","author":"K Iino","year":"2016","journal-title":"Maturitas"},{"issue":"3","key":"pone.0319177.ref059","doi-asserted-by":"crossref","first-page":"233","DOI":"10.31662\/jmaj.2022-0184","article-title":"Studies of health insurance claims data in Japan: a scoping review","volume":"6","author":"M Suto","year":"2023","journal-title":"JMA J"},{"issue":"1","key":"pone.0319177.ref060","doi-asserted-by":"crossref","first-page":"13","DOI":"10.37737\/ace.2.1_13","article-title":"A review of studies using the Japanese national database of health insurance claims and specific health checkups","volume":"2","author":"N Hirose","year":"2020","journal-title":"Ann Clin Epidemiol"},{"key":"pone.0319177.ref061","author":"Hokkaido Health and Welfare Department, Welfare Bureau, Community Welfare Division"},{"key":"pone.0319177.ref062","article-title":"Status of claims by type of claim form.","author":"Social Insurance Medical Payment Fund"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0319177","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T18:38:39Z","timestamp":1740076719000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0319177"}},"subtitle":[],"editor":[{"given":"Preenan","family":"Pillay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,2,20]]},"references-count":62,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0319177","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,20]]}}}