{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T21:42:24Z","timestamp":1789076544776,"version":"build-2803163510"},"reference-count":67,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The relationship between lung function and depression in middle-aged and older adults remains poorly understood. To address this knowledge gap, we conducted cross-sectional and longitudinal analyses using data from the nationally representative China Health and Retirement Longitudinal Study (CHARLS) to examine the association between peak expiratory flow (PEF) status and depression among middle-aged and older Chinese adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 15,137 participants aged 45\u202fyears and older were included from the 2015 China Health and Retirement Longitudinal Study (CHARLS). Participants were categorized into three PEF status groups based on their percentage of predicted PEF: severe impairment (&amp;lt;80%), average lung function (80\u2013100%), and good lung function (\u2265100%). A total of 12,304 participants were included in the longitudinal analysis from 2015 to 2018. To address potential confounding, propensity score matching was employed using a gradient-boosting model to balance covariates between participants with and without depression. Logistic regression analyses as well as restricted cubic spline (RCS) regression analyses were performed to examine the association between (PEF) status and depression incidence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>The prevalence of depression was 9.53% (<jats:italic>n<\/jats:italic>\u202f=\u202f1,044) in the cross-sectional sample, with higher rates observed in participants with poorer lung function (9.53, 7.11, and 5.03% for good, moderately good, and poorer lung function, respectively). During a 3.6-year follow-up, 6.73% (<jats:italic>n<\/jats:italic>\u202f=\u202f130) of participants developed depression. Fully adjusted logistic regression analysis demonstrated a significant inverse linear association between PEF percentage and depression risk (OR: 0.898, 95% CI: 0.862\u20130.935, per 1 SD increase). These findings were corroborated by restricted cubic spline (RCS) regression analysis, which revealed a linear relationship without evidence of nonlinearity (<jats:italic>P<\/jats:italic> for nonlinearity\u202f=\u202f0.631).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study revealed a noteworthy correlation between PEF percentage and depression among the middle-aged and older population. The PEF percentage emerges as a valuable tool that may enhance the primary prevention and treatment of depression.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1551356","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T04:10:37Z","timestamp":1752725437000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Associations between pulmonary function and depression: evidence from the CHARLS cohort 2015\u20132018"],"prefix":"10.3389","volume":"13","author":[{"given":"Hui","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijun","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuejun","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiqing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengping","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/S2215-0366(21)00395-3","article-title":"Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019","volume":"9","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"k4922","DOI":"10.1136\/bmj.k4922","article-title":"Depression in older adults","volume":"363","author":"Wilkinson","year":"2018","journal-title":"BMJ"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1961","DOI":"10.1016\/S0140-6736(05)66665-2","article-title":"Depression in the elderly","volume":"365","author":"Alexopoulos","year":"2005","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.maturitas.2014.03.005","article-title":"Prevention of depression in older age","volume":"79","author":"Almeida","year":"2014","journal-title":"Maturitas"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.arr.2015.08.003","article-title":"A research agenda for aging in China in the 21st century","volume":"24","author":"Fang","year":"2015","journal-title":"Ageing Res Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"132","DOI":"10.5582\/bst.2017.01246","article-title":"Internal migration and regional differences of population aging: an empirical study of 287 cities in China","volume":"12","author":"Chen","year":"2018","journal-title":"Biosci Trends"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1302879","DOI":"10.3389\/fnagi.2023.1302879","article-title":"Associations of sarcopenia, sarcopenia parameters and motoric cognitive risk syndrome in Chinese older adults","volume":"15","author":"Jiang","year":"2023","journal-title":"Front Aging Neurosci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1016\/S2215-0366(21)00251-0","article-title":"Prevalence of depressive disorders and treatment in China: a cross-sectional epidemiological study","volume":"8","author":"Lu","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1177\/0891988719862620","article-title":"Depressive symptoms in elderly Chinese primary care patients: prevalence and sociodemographic and clinical correlates","volume":"32","author":"Zhong","year":"2019","journal-title":"J Geriatr Psychiatry Neurol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"103417","DOI":"10.1016\/j.ajp.2022.103417","article-title":"Global prevalence of depression in older adults: a systematic review and meta-analysis of epidemiological surveys","volume":"80","author":"Cai","year":"2023","journal-title":"Asian J Psychiatr"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.jad.2008.02.008","article-title":"Prevalence and risk factors for depression in non-demented primary care attenders aged 75 years and older","volume":"111","author":"Weyerer","year":"2008","journal-title":"J Affect Disord"},{"key":"ref12","first-page":"465","article-title":"Depression in the elderly: clinical features and risk factors","volume":"3","author":"Sozeri-Varma","year":"2012","journal-title":"Aging Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.jad.2019.09.011","article-title":"Prevalence and recognition of depressive disorders among Chinese older adults receiving primary care: a multi-center cross-sectional study","volume":"260","author":"Zhong","year":"2020","journal-title":"J Affect Disord"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.jpsychires.2016.02.023","article-title":"Exercise as a treatment for depression: a meta-analysis adjusting for publication bias","volume":"77","author":"Schuch","year":"2016","journal-title":"J Psychiatr Res"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"31","DOI":"10.3928\/00989134-20171024-01","article-title":"Effects of exercise interventions on depressive symptoms among community-dwelling older adults in the United States: a systematic review","volume":"44","author":"Seo","year":"2018","journal-title":"J Gerontol Nurs"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1016\/j.jad.2019.07.088","article-title":"The association between cardiorespiratory fitness and the incidence of common mental health disorders: a systematic review and meta-analysis","volume":"257","author":"Kandola","year":"2019","journal-title":"J Affect Disord"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"104797","DOI":"10.1016\/j.archger.2022.104797","article-title":"Too depressed to breathe: the longitudinal association between depressive symptoms and lung function among general middle-aged and older adults","volume":"103","author":"Guo","year":"2022","journal-title":"Arch Gerontol Geriatr"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"6611","DOI":"10.1017\/S0033291722004007","article-title":"Cognitive performance and brain structural connectome alterations in major depressive disorder","volume":"53","author":"Gruber","year":"2023","journal-title":"Psychol Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1097\/PSY.0b013e3182a15672","article-title":"The association of depressive symptoms and pulmonary function in healthy adults","volume":"75","author":"Ochs-Balcom","year":"2013","journal-title":"Psychosom Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"443","DOI":"10.4306\/pi.2015.12.4.443","article-title":"Associations of pulmonary function with dementia and depression in an older Korean population","volume":"12","author":"Yoon","year":"2015","journal-title":"Psychiatry Investig"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2041","DOI":"10.1016\/S0140-6736(09)60660-7","article-title":"Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001-05: an epidemiological survey","volume":"373","author":"Phillips","year":"2009","journal-title":"Lancet"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.jad.2012.02.027","article-title":"Prevalence and natural course of late-life depression in China primary care: a population based study from an urban community","volume":"141","author":"Chen","year":"2012","journal-title":"J Affect Disord"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1093\/ije\/dys203","article-title":"Cohort profile: the China health and retirement longitudinal study (CHARLS)","volume":"43","author":"Zhao","year":"2014","journal-title":"Int J Epidemiol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e101054","DOI":"10.1136\/gpsych-2023-101054","article-title":"Relationship between left-behind status and cognitive function in older Chinese adults: a prospective 3-year cohort study","volume":"36","author":"Zhang","year":"2023","journal-title":"Gen Psychiatr"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1192\/bjp.145.6.641","article-title":"Marital intimacy and depression","volume":"145","author":"Waring","year":"1984","journal-title":"Br J Psychiatry"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1093\/aje\/kwr503","article-title":"Limited lung function: impact of reduced peak expiratory flow on health status, health-care utilization, and expected survival in older adults","volume":"176","author":"Roberts","year":"2012","journal-title":"Am J Epidemiol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1002\/(SICI)1099-1166(199908)14:8<608::AID-GPS991>3.0.CO;2-Z","article-title":"Cross-validation of a short form of the CES-D in Chinese elderly","volume":"14","author":"Boey","year":"1999","journal-title":"Int J Geriatr Psychiatry"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1017\/S1041610213001701","article-title":"Factorial validity of the Center for Epidemiologic Studies Depression Scale short form in older population in China","volume":"26","author":"Chen","year":"2014","journal-title":"Int Psychogeriatr"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"21","DOI":"10.3389\/fnbot.2013.00021","article-title":"Gradient boosting machines, a tutorial","volume":"7","author":"Natekin","year":"2013","journal-title":"Front Neurorobot"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"2372","DOI":"10.3389\/fpsyg.2018.02372","article-title":"Contingencies of self-worth on positive and negative events and their relationships to depression","volume":"9","author":"Liu","year":"2018","journal-title":"Front Psychol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"818542","DOI":"10.3389\/fpsyt.2022.818542","article-title":"The psychopathology of worthlessness in depression","volume":"13","author":"Harrison","year":"2022","journal-title":"Front Psych"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1186\/s12888-015-0636-1","article-title":"Direct and indirect influences of childhood abuse on depression symptoms in patients with major depressive disorder","volume":"15","author":"Hayashi","year":"2015","journal-title":"BMC Psychiatry"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1016\/j.jaac.2019.10.011","article-title":"Meta-analysis: exposure to early life stress and risk for depression in childhood and adolescence","volume":"59","author":"LeMoult","year":"2020","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1016\/S2215-0366(22)00227-9","article-title":"Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis","volume":"9","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.jad.2023.04.071","article-title":"The impact of adverse childhood experiences on adult depression severity and treatment outcomes","volume":"333","author":"Giampetruzzi","year":"2023","journal-title":"J Affect Disord"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.cpr.2007.04.007","article-title":"The marital context of depression: research, limitations, and new directions","volume":"28","author":"Rehman","year":"2008","journal-title":"Clin Psychol Rev"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1146\/annurev-clinpsy-081219-103323","article-title":"Intimate relationships and depression: searching for causation in the sea of association","volume":"17","author":"Whisman","year":"2021","journal-title":"Annu Rev Clin Psychol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/s12888-024-05506-8","article-title":"The relationship between academic stress and depression among college students during the COVID-19 pandemic: a cross-sectional study from China","volume":"24","author":"Chen","year":"2024","journal-title":"BMC Psychiatry"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s40359-023-01498-4","article-title":"The relationship between loneliness and problematic social media usage in Chinese university students: a longitudinal study","volume":"12","author":"Wu","year":"2024","journal-title":"BMC Psychol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s13195-015-0116-3","article-title":"Lung disease as a determinant of cognitive decline and dementia","volume":"7","author":"Dodd","year":"2015","journal-title":"Alzheimers Res Ther"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1186\/s13054-019-2626-z","article-title":"Long-term cognitive impairment after acute respiratory distress syndrome: a review of clinical impact and pathophysiological mechanisms","volume":"23","author":"Sasannejad","year":"2019","journal-title":"Crit Care"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1186\/s12877-023-04554-1","article-title":"Frailty, cognitive impairment, and depressive symptoms in Chinese older adults: an eight-year multi-trajectory analysis","volume":"23","author":"Yuan","year":"2023","journal-title":"BMC Geriatr"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e0169764","DOI":"10.1371\/journal.pone.0169764","article-title":"Social inequalities and depressive symptoms in adults: the role of objective and subjective socioeconomic status","volume":"12","author":"Hoebel","year":"2017","journal-title":"PLoS One"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"39","DOI":"10.3928\/02793695-20200817-02","article-title":"The relationship between self-care agency and depression in older adults and influencing factors","volume":"58","author":"Isik","year":"2020","journal-title":"J Psychosoc Nurs Ment Health Serv"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1177\/147323001103900402","article-title":"Marital status and risk for late life depression: a meta-analysis of the published literature","volume":"39","author":"Yan","year":"2011","journal-title":"J Int Med Res"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e42","DOI":"10.1017\/S2045796021000342","article-title":"Role of age, gender and marital status in prognosis for adults with depression: an individual patient data meta-analysis","volume":"30","author":"Buckman","year":"2021","journal-title":"Epidemiol Psychiatr Sci"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1093\/eurpub\/ckr001","article-title":"Variations between world regions in individual health: a multilevel analysis of the role of socio-economic factors","volume":"22","author":"Witvliet","year":"2012","journal-title":"Eur J Pub Health"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1016\/j.mcna.2004.06.007","article-title":"Smoking and depression","volume":"88","author":"Paperwalla","year":"2004","journal-title":"Med Clin North Am"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1075563","DOI":"10.3389\/fnagi.2023.1075563","article-title":"Are social isolation and loneliness associated with cognitive decline in ageing?","volume":"15","author":"Cardona","year":"2023","journal-title":"Front Aging Neurosci"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"CD013540","DOI":"10.1002\/14651858.CD013540.pub2","article-title":"Anticholinergic burden (prognostic factor) for prediction of dementia or cognitive decline in older adults with no known cognitive syndrome","volume":"5","author":"Taylor-Rowan","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"101336","DOI":"10.1016\/j.eclinm.2022.101336","article-title":"Malnutrition is positively associated with cognitive decline in centenarians and oldest-old adults: a cross-sectional study","volume":"47","author":"Feng","year":"2022","journal-title":"EClinicalMedicine"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"33","DOI":"10.3233\/JAD-150528","article-title":"Nutritional status is associated with faster cognitive decline and worse functional impairment in the progression of dementia: the Cache County dementia progression Study1","volume":"52","author":"Sanders","year":"2016","journal-title":"J Alzheimers Dis"},{"key":"ref53","first-page":"412","article-title":"Risk of depression in patients with chronic obstructive pulmonary disease and its determinants","volume-title":"Thorax","author":"van Manen","year":"2002"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1136\/thx.2005.053058","article-title":"Ageing, smoking and oxidative stress","volume":"61","author":"Donohue","year":"2006","journal-title":"Thorax"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1007\/s43188-023-00223-y","article-title":"Short-term inhalation exposure to cigarette smoke induces oxidative stress and inflammation in lungs without systemic oxidative stress in mice","volume":"40","author":"Seo","year":"2024","journal-title":"Toxicol Res"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"2396","DOI":"10.1001\/jama.2020.23068","article-title":"Association between depressive symptoms and incident cardiovascular diseases","volume":"324","author":"Harshfield","year":"2020","journal-title":"JAMA"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"1093935","DOI":"10.3389\/fpubh.2023.1093935","article-title":"Association between depression and lung function in college students","volume":"11","author":"Wang","year":"2023","journal-title":"Front Public Health"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s13690-024-01322-4","article-title":"Association between tobacco smoke exposure and depression: the NHANES 2005-2018 and Mendelian randomization study","volume":"82","author":"Guo","year":"2024","journal-title":"Arch Public Health"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1186\/s12916-024-03382-3","article-title":"Association and biological pathways between lung function and incident depression: a prospective cohort study of 280,032 participants","volume":"22","author":"Hu","year":"2024","journal-title":"BMC Med"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1097\/PSY.0b013e3181c2ca39","article-title":"Low respiratory function increases the risk of depressive symptoms in later life in men","volume":"72","author":"Giltay","year":"2010","journal-title":"Psychosom Med"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/1465-9921-12-3","article-title":"Biomarkers of systemic inflammation and depression and fatigue in moderate clinically stable COPD","volume":"12","author":"Al-shair","year":"2011","journal-title":"Respir Res"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.psyneuen.2014.04.020","article-title":"Association of pro-inflammatory cytokines, cortisol and depression in patients with chronic obstructive pulmonary disease","volume":"46","author":"Du","year":"2014","journal-title":"Psychoneuroendocrinology"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"726","DOI":"10.3390\/ijms23147726","article-title":"The role of Neurotrophin signaling in age-related cognitive decline and cognitive diseases","volume":"23","author":"Numakawa","year":"2022","journal-title":"Int J Mol Sci"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1080\/1040841X.2021.1960483","article-title":"Lung-brain axis","volume":"48","author":"Bajinka","year":"2022","journal-title":"Crit Rev Microbiol"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1016\/j.immuni.2022.03.015","article-title":"The lung-brain axis: a new frontier in host-microbe interactions","volume":"55","author":"Azzoni","year":"2022","journal-title":"Immunity"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1186\/s40168-024-01893-y","article-title":"Microbiome and metabolome patterns after lung transplantation reflect underlying disease and chronic lung allograft dysfunction","volume":"12","author":"Martin","year":"2024","journal-title":"Microbiome"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"1000167","DOI":"10.4172\/1994-8220.1000167","article-title":"Depression and its correlates in South Africa and Ghana among people aged 50 and above: findings from the WHO study on global AGEing and adult health","volume":"17","author":"Thapa","year":"2014","journal-title":"J Psychiatry"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1551356\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T04:10:38Z","timestamp":1752725438000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1551356\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,17]]},"references-count":67,"alternative-id":["10.3389\/fpubh.2025.1551356"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1551356","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,17]]},"article-number":"1551356"}}