{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:50:23Z","timestamp":1792788623181,"version":"4.5.0"},"reference-count":56,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"African Population and Health Research Centre","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"https:\/\/ror.org\/032ztsj35","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Makerere University Centre for Artificial Intelligence","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"https:\/\/ror.org\/03dmz0111","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Stroke is a leading cause of mortality and disability globally, with a disproportionate and growing burden in low- and middle-income Countries. However, evidence on national temporal trends and potential impacts in Uganda remains limited. This study examined trends in stroke cases and deaths in Uganda and forecast of future stroke burden through December 2028.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective time-series analysis of District Health Information System (DHIS2) from 2016 to 2025. Monthly stroke cases, and deaths were analyzed. Monthly populations of Uganda were estimated using exponential growth interpolation and incorporated as an offset term in Bayesian negative binomial regression models to estimate incidence rate ratios (IRR) at 95% confidence interval (CI). Decomposition analysis using the Kitagawa method was applied to derive contributions from population growth and epidemiological change, based on model estimates. Stationarity and autocorrelation were assessed using the unit root and Ljung\u2013Box tests. Forecasting was performed using the exponential smoothing state-space (ETS) model at 80% prediction intervals (PI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Trend analysis showed sustained monthly increases in stroke incidence and mortality with IRR; 1.005 (95% CI: 1.004\u20131.006), and 1.006 (95% CI: 1.005\u20131.007), respectively (all p\u2009&lt;\u20090.001). The epidemiological effect was approximately twice as large as the population effect, indicating that the majority of the increase in stroke cases and deaths is attributable to rising incidence rates rather than population growth alone. ETS model demonstrated that by December 2028, monthly cases and deaths are projected to reach approximately 927 (80% PI: 709\u20131,156) and 126 (80% PI: 94\u2013160), respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Stroke burden in Uganda is projected to continue increase further over the next years in the absence of effective prevention measures. Strengthened primary prevention, expanded acute stroke care capacity, and improved surveillance systems are urgently needed to mitigate the growing health system impact.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360963","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:30:50Z","timestamp":1792171850000},"page":"e0360963","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rising stroke burden in Uganda: A national time-series analysis and forecasts, 2016\u20132028"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2655-4744","authenticated-orcid":true,"given":"Suzan","family":"Nakasendwa","sequence":"first","affiliation":[{"name":"Makerere University","place":["Kampala, Uganda"],"department":["Department of Epidemiology and Biostatistics, School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan Nankya","family":"Mutyoba","sequence":"additional","affiliation":[{"name":"Makerere University","place":["Kampala, Uganda"],"department":["Department of Epidemiology and Biostatistics, School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex Riolexus","family":"Ario","sequence":"additional","affiliation":[{"name":"Uganda National Institute of Public Health, Ministry of Health","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1779-1043","authenticated-orcid":true,"given":"Evans","family":"Omondi","sequence":"additional","affiliation":[{"name":"African Population and Health Research Centre","place":["Nairobi, Kenya"]},{"name":"Institute of Mathematical Sciences, Strathmore University","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda Birungi","family":"Bashemera","sequence":"additional","affiliation":[{"name":"College of Computing and Information Sciences, Makerere University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Kakooza","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Letisha","family":"Najjemba","sequence":"additional","affiliation":[{"name":"Committee on Data of the International Science Council \u2013 CODATA","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce Nakatumba","family":"Nabende","sequence":"additional","affiliation":[{"name":"College of Computing and Information Sciences, Makerere University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3563-0224","authenticated-orcid":true,"given":"David","family":"Guwatudde","sequence":"additional","affiliation":[{"name":"Makerere University","place":["Kampala, Uganda"],"department":["Department of Epidemiology and Biostatistics, School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes","family":"Kiragga","sequence":"additional","affiliation":[{"name":"Institute of Mathematical Sciences, Strathmore University","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"issue":"10","key":"pone.0360963.ref001","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"20","author":"VL Feigin","year":"2021","journal-title":"Lancet Neurol"},{"issue":"10","key":"pone.0360963.ref002","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/S1474-4422(24)00369-7","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132021: A systematic analysis for the Global Burden of Disease Study 2021","volume":"23","author":"VL Feigin","year":"2024","journal-title":"Lancet Neurol"},{"issue":"8","key":"pone.0360963.ref003","doi-asserted-by":"crossref","first-page":"107733","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107733","article-title":"A systematic review of the epidemiology and the public health implications of stroke in Sub-Saharan Africa","volume":"33","author":"G Abissegue","year":"2024","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"4","key":"pone.0360963.ref004","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/S1474-4422(09)70023-7","article-title":"Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling","volume":"8","author":"SC Johnston","year":"2009","journal-title":"Lancet Neurol"},{"issue":"4","key":"pone.0360963.ref005","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1111\/j.1747-4949.2006.00064.x","article-title":"The neglected burden of stroke in Sub-Saharan Africa","volume":"1","author":"AP Kengne","year":"2006","journal-title":"Int J Stroke"},{"issue":"10","key":"pone.0360963.ref006","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1038\/s41582-021-00542-4","article-title":"Stroke in Africa: Profile, progress, prospects and priorities","volume":"17","author":"RO Akinyemi","year":"2021","journal-title":"Nat Rev Neurol"},{"key":"pone.0360963.ref007","doi-asserted-by":"crossref","DOI":"10.5830\/CVJA-2015-038","article-title":"The burden of stroke in Africa: A glance at the present and a glimpse into the future","volume":"26","author":"MO Owolabi","year":"2015","journal-title":"Cardiovasc J Afr"},{"issue":"2","key":"pone.0360963.ref008","doi-asserted-by":"crossref","first-page":"2804","DOI":"10.36922\/an.2804","article-title":"Stroke care in sub-Saharan Africa: Evaluating the present landscape and proposing strategies for improving outcomes","volume":"3","author":"FE Chukwudelunzu","year":"2024","journal-title":"Adv Neurol"},{"issue":"13","key":"pone.0360963.ref009","doi-asserted-by":"crossref","DOI":"10.3201\/eid2813.220711","article-title":"Extending and strengthening routine DHIS2 surveillance systems for COVID-19 responses in Sierra Leone, Sri Lanka, and Uganda","volume":"28","author":"C Kinkade","year":"2022","journal-title":"Emerg Infect Dis"},{"key":"pone.0360963.ref010","article-title":"Thirty-day stroke mortality and associated clinical and laboratory factors among adult stroke patients admitted at Mulago Hospital (Uganda)","journal-title":"African Journal of Neurological Sciences"},{"key":"pone.0360963.ref011","year":"2025"},{"issue":"10","key":"pone.0360963.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001892","article-title":"Thirty-day mortality rates among young adult stroke patients and their characteristics at Kiruddu and Mulago hospitals in Uganda: A prospective observational cohort study","volume":"3","author":"AM Nampogo","year":"2023","journal-title":"PLOS Glob Public Health"},{"issue":"5","key":"pone.0360963.ref013","doi-asserted-by":"crossref","first-page":"105661","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.105661","article-title":"Stroke mortality outcomes in Uganda","volume":"30","author":"S Olum","year":"2021","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"1","key":"pone.0360963.ref014","doi-asserted-by":"crossref","DOI":"10.1016\/S2468-2667(21)00230-9","article-title":"Primary stroke prevention worldwide: Translating evidence into action","volume":"7","author":"MO Owolabi","year":"2022","journal-title":"Lancet Public Health"},{"issue":"1","key":"pone.0360963.ref015","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1186\/s12889-023-15979-z","article-title":"A roadmap for using DHIS2 data to track progress in key health indicators in the Global South: experience from sub-saharan Africa","volume":"23","author":"A Farnham","year":"2023","journal-title":"BMC Public Health"},{"key":"pone.0360963.ref016","author":"DHIS2 Hosting & Support \u2013 Secure & Reliable"},{"issue":"1","key":"pone.0360963.ref017","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1093\/heapol\/czv029","article-title":"Using routine health information systems for well-designed health evaluations in low- and middle-income countries","volume":"31","author":"BH Wagenaar","year":"2016","journal-title":"Health Policy Plan"},{"issue":"1","key":"pone.0360963.ref018","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0211265","article-title":"Quality of routine facility data for monitoring priority maternal and newborn indicators in DHIS2: A case study from Gombe State, Nigeria","volume":"14","author":"AA Bhattacharya","year":"2019","journal-title":"PLoS One"},{"key":"pone.0360963.ref019","article-title":"Barriers and facilitators of the effective use of DHIS2 data to improve program planning and monitoring in Uganda: A sequential mixed methods study","volume":"4","author":"SN Kiwanuka","year":"2026","journal-title":"Oxf Open Digit Health"},{"key":"pone.0360963.ref020","first-page":"849","article-title":"Comparative effectiveness of DHIS2 and FAIR data approaches for privacy-preserving health data analytics in Uganda: A systematic review","volume":"17","author":"M Basajja","year":"2025","journal-title":"Clin Outcomes Res CEOR"},{"issue":"1","key":"pone.0360963.ref021","doi-asserted-by":"crossref","first-page":"2150","DOI":"10.1186\/s12889-025-23318-7","article-title":"Hybrid time series and machine learning models for forecasting cardiovascular mortality in India: An age specific analysis","volume":"25","author":"MD Teja","year":"2025","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0360963.ref022","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1186\/s12911-020-01256-1","article-title":"Medical service demand forecasting using a hybrid model based on ARIMA and self-adaptive filtering method","volume":"20","author":"Y Huang","year":"2020","journal-title":"BMC Med Inform Decis Mak"},{"key":"pone.0360963.ref023","year":"2026"},{"key":"pone.0360963.ref024","article-title":"Components of a difference between two rates*","author":"EM Kitagawa","year":"1955","journal-title":"J Am Stat Assoc"},{"issue":"6","key":"pone.0360963.ref025","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1097\/MLR.0000000000001849","article-title":"Using the Kitagawa Decomposition to Measure Overall \u2013 and Individual Facility Contributions to \u2013 Within-facility and Between-facility Differences: Analyzing Racial and Ethnic Wait Time Disparities in the Veterans Health Administration (VA)","volume":"61","author":"M Shwartz","year":"2023","journal-title":"Med Care"},{"issue":"2","key":"pone.0360963.ref026","doi-asserted-by":"crossref","DOI":"10.1111\/gean.70033","article-title":"Arriaga meets kitagawa. Life expectancy decomposition with population subgroups","volume":"58","author":"T Riffe","year":"2026","journal-title":"Geogr Anal"},{"key":"pone.0360963.ref027","article-title":"Health service utilization and delivery during the COVID-19 pandemic in Uganda between 2020 and 2022: Implications for the future pandemics","author":"V Kembabazi","year":"2026","journal-title":"BMC Public Health"},{"issue":"8","key":"pone.0360963.ref028","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0005046","article-title":"\u201cResilience amidst challenges\u201d: Healthcare users\u2019 experiences of access and utilisation of primary healthcare services during the COVID-19 pandemic in southwestern Uganda","volume":"5","author":"R Kawuma","year":"2025","journal-title":"PLOS Glob Public Health"},{"issue":"1","key":"pone.0360963.ref029","doi-asserted-by":"crossref","first-page":"31408","DOI":"10.1038\/s41598-024-83016-z","article-title":"Impact of COVID-19 pandemic on acute stroke care in a tertiary stroke centre","volume":"14","author":"M H\u00e9ja","year":"2024","journal-title":"Sci Rep"},{"key":"pone.0360963.ref030","article-title":"Reductions in hospital admissions and delays in acute stroke care during the pandemic of COVID-19","author":"Y Wu","year":"2020","journal-title":"Front Neurol"},{"issue":"3","key":"pone.0360963.ref031","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1177\/17474930211005373","article-title":"COVID-19 and stroke-Understanding the relationship and adapting services. A global World Stroke Organisation perspective","volume":"16","author":"HS Markus","year":"2021","journal-title":"Int J Stroke"},{"key":"pone.0360963.ref032","year":"2023"},{"key":"pone.0360963.ref033","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1186\/s12913-022-08598-8","article-title":"Routine use of DHIS2 data: A scoping review","volume":"22","author":"E Byrne","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"pone.0360963.ref034","article-title":"Regional burden and region-specific stroke risk factors in lower and middle-income countries","volume-title":"The global burden of stroke and changing risk factors","author":"ZK Law","year":"2025"},{"issue":"11","key":"pone.0360963.ref035","doi-asserted-by":"crossref","first-page":"2463","DOI":"10.1161\/STROKEAHA.110.594275","article-title":"An Epidemiological Study of Stroke Hospitalizations in Maputo, Mozambique","volume":"41","author":"A Damasceno","year":"2010","journal-title":"Stroke"},{"key":"pone.0360963.ref036","first-page":"767","article-title":"Door-to-door survey of major neurological disorders (project) in Al Quseir City, Red Sea Governorate, Egypt","volume":"9","author":"HNE Tallawy","year":"2013","journal-title":"Neuropsychiatr Dis Treat"},{"key":"pone.0360963.ref037","first-page":"1785","article-title":"Epidemiology of nonfatal stroke and transient ischemic attack in Al-Kharga District, New Valley, Egypt","volume":"9","author":"WM Farghaly","year":"2013","journal-title":"Neuropsychiatr Dis Treat"},{"issue":"8","key":"pone.0360963.ref038","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/S1474-4422(10)70144-7","article-title":"Stroke incidence in rural and urban Tanzania: A prospective, community-based study","volume":"9","author":"R Walker","year":"2010","journal-title":"Lancet Neurol"},{"issue":"3","key":"pone.0360963.ref039","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1002\/acn3.51507","article-title":"Younger age of stroke in low-middle income countries is related to healthcare access and quality","volume":"9","author":"MH Rahbar","year":"2022","journal-title":"Ann Clin Transl Neurol"},{"issue":"11","key":"pone.0360963.ref040","doi-asserted-by":"crossref","first-page":"2925","DOI":"10.1161\/STROKEAHA.117.018531","article-title":"Increase of stroke incidence in young adults in a middle-income country","volume":"48","author":"NL Cabral","year":"2017","journal-title":"Stroke"},{"issue":"4","key":"pone.0360963.ref041","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0003755","article-title":"Changes in the prevalence of the common risk factors for non-communicable diseases in Uganda between 2014 and 2023: Informed by nationally representative cross-sectional surveys","volume":"5","author":"R Kusolo","year":"2025","journal-title":"PLOS Glob Public Health"},{"issue":"2","key":"pone.0360963.ref042","doi-asserted-by":"crossref","first-page":"26","DOI":"10.3390\/idr17020026","article-title":"Advances in the management of infectious diseases","volume":"17","author":"RF Omar","year":"2025","journal-title":"Infect Dis Rep"},{"key":"pone.0360963.ref043","doi-asserted-by":"crossref","first-page":"785607","DOI":"10.3389\/fneur.2021.785607","article-title":"Stroke epidemiology, care, and outcomes in Kenya: A scoping review","volume":"12","author":"P Waweru","year":"2021","journal-title":"Front Neurol"},{"issue":"6","key":"pone.0360963.ref044","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1177\/17474930221147164","article-title":"Stroke in Africa: A systematic review and meta-analysis of the incidence and case-fatality rates","volume":"18","author":"AP Okekunle","year":"2023","journal-title":"Int J Stroke"},{"issue":"1","key":"pone.0360963.ref045","article-title":"A perspective on the burden of stroke among young adults in Africa","volume":"22","author":"T Napoleon","year":"2025","journal-title":"Discov Public Health"},{"key":"pone.0360963.ref046","article-title":"Global burden of stroke: Insights and trends from GBD 2021","volume-title":"The global burden of stroke and changing risk factors","author":"BMT Luu","year":"2025"},{"issue":"3","key":"pone.0360963.ref047","doi-asserted-by":"crossref","first-page":"108241","DOI":"10.1016\/j.jstrokecerebrovasdis.2025.108241","article-title":"Burden and risk factors of stroke in Vietnam from 1990 to 2021 - A systematic analysis from global burden disease 2021","volume":"34","author":"TTTT Truyen","year":"2025","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"1","key":"pone.0360963.ref048","doi-asserted-by":"crossref","first-page":"25370","DOI":"10.1038\/s41598-025-10840-2","article-title":"Trends in stroke incidence and mortality in China, Japan, and South Korea (1990-2021) with projections to 2035","volume":"15","author":"L Yang","year":"2025","journal-title":"Sci Rep"},{"issue":"9","key":"pone.0360963.ref049","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1177\/17474930211066416","article-title":"Stroke services in Africa: What is there and what is needed","volume":"17","author":"T Roushdy","year":"2022","journal-title":"Int J Stroke"},{"issue":"1","key":"pone.0360963.ref050","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1159\/000545954","article-title":"Implementing acute stroke services in Sub-Saharan Africa: Steps, progress, and perspectives from the tanzania stroke project","volume":"15","author":"SS Matuja","year":"2025","journal-title":"Cerebrovasc Dis Extra"},{"issue":"12","key":"pone.0360963.ref051","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/S1474-4422(23)00277-6","article-title":"Pragmatic solutions to reduce the global burden of stroke: A World Stroke Organization-Lancet Neurology Commission","volume":"22","author":"World Stroke Organization\u2013Lancet Neurology Commission Stroke Collaboration Group","year":"2023","journal-title":"Lancet Neurol"},{"issue":"1","key":"pone.0360963.ref052","article-title":"Trends in stroke mortality rates in low- and middle-income countries (2010\u20132025): An umbrella review","volume":"9","author":"N Aderinto","year":"2026","journal-title":"IJS Glob Health"},{"key":"pone.0360963.ref053","doi-asserted-by":"crossref","first-page":"120641","DOI":"10.1016\/j.jns.2023.120641","article-title":"Participation by patients from low- and middle-income countries (LMICs) in trial evidence supporting secondary stroke prevention guideline recommendations","volume":"448","author":"PA Opare-Addo","year":"2023","journal-title":"J Neurol Sci"},{"issue":"1","key":"pone.0360963.ref054","doi-asserted-by":"crossref","first-page":"1988280","DOI":"10.1080\/16549716.2021.1988280","article-title":"Community-funded integrated care outreach clinics as a capacity building strategy to expand access to health care in remote areas of Uganda","volume":"14","author":"RG Kinney","year":"2021","journal-title":"Glob Health Action"},{"issue":"6","key":"pone.0360963.ref055","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0251662","article-title":"Reducing stroke burden through a targeted self-management intervention for reducing stroke risk factors in high-risk Ugandans: A protocol for a randomized controlled trial","volume":"16","author":"M Kaddumukasa","year":"2021","journal-title":"PLoS One"},{"key":"pone.0360963.ref056","author":"S Nakasendwa","year":"2026"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360963","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:30:59Z","timestamp":1792171859000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360963"}},"subtitle":[],"editor":[{"given":"Thien Tan Tri Tai","family":"Truyen","sequence":"first","affiliation":[{"name":"Cedars-Sinai Medical Center","place":["UNITED STATES OF AMERICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":56,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0360963","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]}}}