{"id":"https://openalex.org/W7225246902","doi":"https://doi.org/10.21203/rs.3.rs-11011142/v1","title":"Frailty\u2013depressive symptom transitions in relation to subsequent change in function-weighted multimorbidity burden: a longitudinal CHARLS study, 2011\u20132018","display_name":"Frailty\u2013depressive symptom transitions in relation to subsequent change in function-weighted multimorbidity burden: a longitudinal CHARLS study, 2011\u20132018","publication_year":2026,"publication_date":"2026-11-05","ids":{"openalex":"https://openalex.org/W7225246902","doi":"https://doi.org/10.21203/rs.3.rs-11011142/v1"},"language":"en","primary_location":{"id":"doi:10.21203/rs.3.rs-11011142/v1","doi":"https://doi.org/10.21203/rs.3.rs-11011142/v1","is_oa":true,"landing_page_url":"https://doi.org/10.21203/rs.3.rs-11011142/v1","pdf_url":"https://www.researchsquare.com/article/rs-11011142/latest.pdf","source":{"id":"https://openalex.org/S4306525896","display_name":"Research Square","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"Research Square","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.researchsquare.com/article/rs-11011142/latest.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5042156189","display_name":"Mingyun Huang","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I47720641","display_name":"Huazhong University of Science and Technology","ror":"https://ror.org/00p991c53","country_code":"CN","type":"education","lineage":["https://openalex.org/I47720641"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Mingyun Huang","raw_affiliation_strings":["Huazhong University of Science and Technology"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Huazhong University of Science and Technology","institution_ids":["https://openalex.org/I47720641"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5019037484","display_name":"\u9ad8\u7ea2\u971e","orcid":"https://orcid.org/0000-0001-8142-7011","observed_orcids":["https://orcid.org/0000-0001-8142-7011"]},"institutions":[{"id":"https://openalex.org/I47720641","display_name":"Huazhong University of Science and Technology","ror":"https://ror.org/00p991c53","country_code":"CN","type":"education","lineage":["https://openalex.org/I47720641"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Hongxia Gao","raw_affiliation_strings":["Huazhong University of Science and Technology"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Huazhong University of Science and Technology","institution_ids":["https://openalex.org/I47720641"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160624551","display_name":"Cheng Chen","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I47720641","display_name":"Huazhong University of Science and Technology","ror":"https://ror.org/00p991c53","country_code":"CN","type":"education","lineage":["https://openalex.org/I47720641"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Cheng Chen","raw_affiliation_strings":["Huazhong University of Science and Technology"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Huazhong University of Science and Technology","institution_ids":["https://openalex.org/I47720641"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160664932","display_name":"Yuanyuan Zou","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I47720641","display_name":"Huazhong University of Science and Technology","ror":"https://ror.org/00p991c53","country_code":"CN","type":"education","lineage":["https://openalex.org/I47720641"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Yuanyuan Zou","raw_affiliation_strings":["Huazhong University of Science and Technology"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Huazhong University of Science and Technology","institution_ids":["https://openalex.org/I47720641"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160631260","display_name":"Yanjing Zhang","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I47720641","display_name":"Huazhong University of Science and Technology","ror":"https://ror.org/00p991c53","country_code":"CN","type":"education","lineage":["https://openalex.org/I47720641"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Yanjing Zhang","raw_affiliation_strings":["Huazhong University of Science and Technology"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Huazhong University of Science and Technology","institution_ids":["https://openalex.org/I47720641"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5160616446","display_name":"Yiran Chen","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I47720641","display_name":"Huazhong University of Science and Technology","ror":"https://ror.org/00p991c53","country_code":"CN","type":"education","lineage":["https://openalex.org/I47720641"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Yiran Chen","raw_affiliation_strings":["Huazhong University of Science and Technology"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Huazhong University of Science and Technology","institution_ids":["https://openalex.org/I47720641"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":[],"corresponding_institution_ids":["https://openalex.org/I47720641"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12246","display_name":"Chronic Disease Management Strategies","score":0.7856000065803528,"subfield":{"id":"https://openalex.org/subfields/2713","display_name":"Epidemiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12246","display_name":"Chronic Disease Management Strategies","score":0.7856000065803528,"subfield":{"id":"https://openalex.org/subfields/2713","display_name":"Epidemiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11011","display_name":"Frailty in Older Adults","score":0.18469999730587006,"subfield":{"id":"https://openalex.org/subfields/2717","display_name":"Geriatrics and Gerontology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10235","display_name":"Health disparities and outcomes","score":0.009100000374019146,"subfield":{"id":"https://openalex.org/subfields/3306","display_name":"Health"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/frailty","display_name":"frailty","score":0.9810000061988831},{"id":"https://openalex.org/keywords/depressive-symptoms","display_name":"depressive symptoms","score":0.9950000047683716},{"id":"https://openalex.org/keywords/multimorbidity","display_name":"multimorbidity","score":0.8619999885559082},{"id":"https://openalex.org/keywords/multimorbidity-burden","display_name":"multimorbidity burden","score":0.6930000185966492},{"id":"https://openalex.org/keywords/socioeconomic-inequality","display_name":"socioeconomic disparities","score":0.7360000014305115},{"id":"https://openalex.org/keywords/household-consumption","display_name":"household consumption","score":0.7020000219345093},{"id":"https://openalex.org/keywords/older-adults","display_name":"older adults","score":0.675000011920929},{"id":"https://openalex.org/keywords/middle-aged-adults","display_name":"middle-aged adults","score":0.8529999852180481},{"id":"https://openalex.org/keywords/china-health-and-retirement-longitudinal-study","display_name":"China Health and Retirement Longitudinal Study","score":0.7929999828338623},{"id":"https://openalex.org/keywords/concentration-index","display_name":"concentration index","score":0.43299999833106995},{"id":"https://openalex.org/keywords/health-transition","display_name":"health transition","score":0.3269999921321869},{"id":"https://openalex.org/keywords/physical-functioning","display_name":"physical function","score":0.3610000014305115}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.6730999946594238},{"id":"https://openalex.org/C73269764","wikidata":"https://www.wikidata.org/wiki/Q954529","display_name":"Poisson regression","level":3,"score":0.609499990940094},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.6079000234603882},{"id":"https://openalex.org/C2777895361","wikidata":"https://www.wikidata.org/wiki/Q1758614","display_name":"Longitudinal study","level":2,"score":0.5730999708175659},{"id":"https://openalex.org/C2909273474","wikidata":"https://www.wikidata.org/wiki/Q1952420","display_name":"Multimorbidity","level":3,"score":0.486299991607666},{"id":"https://openalex.org/C48921125","wikidata":"https://www.wikidata.org/wiki/Q10861030","display_name":"Linear regression","level":2,"score":0.4569000005722046},{"id":"https://openalex.org/C2780221984","wikidata":"https://www.wikidata.org/wiki/Q131191","display_name":"Body mass index","level":2,"score":0.4512999951839447},{"id":"https://openalex.org/C26831200","wikidata":"https://www.wikidata.org/wiki/Q16963953","display_name":"Marginal structural model","level":3,"score":0.4481000006198883},{"id":"https://openalex.org/C147077947","wikidata":"https://www.wikidata.org/wiki/Q1515895","display_name":"Socioeconomic status","level":3,"score":0.44339999556541443},{"id":"https://openalex.org/C82789193","wikidata":"https://www.wikidata.org/wiki/Q2142611","display_name":"Relative risk","level":3,"score":0.4075999855995178},{"id":"https://openalex.org/C68443243","wikidata":"https://www.wikidata.org/wiki/Q2786686","display_name":"Quartile","level":3,"score":0.40639999508857727},{"id":"https://openalex.org/C95713431","wikidata":"https://www.wikidata.org/wiki/Q631425","display_name":"Vulnerability (computing)","level":2,"score":0.3880000114440918},{"id":"https://openalex.org/C50382708","wikidata":"https://www.wikidata.org/wiki/Q223218","display_name":"Proportional hazards model","level":2,"score":0.3750999867916107},{"id":"https://openalex.org/C74909509","wikidata":"https://www.wikidata.org/wiki/Q10387","display_name":"Gerontology","level":1,"score":0.37459999322891235},{"id":"https://openalex.org/C107130276","wikidata":"https://www.wikidata.org/wiki/Q133805","display_name":"Epidemiology","level":2,"score":0.35499998927116394},{"id":"https://openalex.org/C168743327","wikidata":"https://www.wikidata.org/wiki/Q1826427","display_name":"Random effects model","level":3,"score":0.35260000824928284},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.3409999907016754},{"id":"https://openalex.org/C120195587","wikidata":"https://www.wikidata.org/wiki/Q2138790","display_name":"Absolute risk reduction","level":3,"score":0.3402000069618225},{"id":"https://openalex.org/C152877465","wikidata":"https://www.wikidata.org/wiki/Q208042","display_name":"Regression analysis","level":2,"score":0.32679998874664307},{"id":"https://openalex.org/C2780623907","wikidata":"https://www.wikidata.org/wiki/Q106394435","display_name":"Disadvantaged","level":2,"score":0.32260000705718994},{"id":"https://openalex.org/C50440223","wikidata":"https://www.wikidata.org/wiki/Q1475848","display_name":"Risk factor","level":2,"score":0.31139999628067017},{"id":"https://openalex.org/C77350462","wikidata":"https://www.wikidata.org/wiki/Q1125472","display_name":"Confounding","level":2,"score":0.30790001153945923},{"id":"https://openalex.org/C2777382242","wikidata":"https://www.wikidata.org/wiki/Q6017816","display_name":"Index (typography)","level":2,"score":0.3077000081539154},{"id":"https://openalex.org/C3020672099","wikidata":"https://www.wikidata.org/wiki/Q857354","display_name":"Longitudinal data","level":2,"score":0.29919999837875366},{"id":"https://openalex.org/C83546350","wikidata":"https://www.wikidata.org/wiki/Q1139051","display_name":"Regression","level":2,"score":0.29789999127388},{"id":"https://openalex.org/C100906024","wikidata":"https://www.wikidata.org/wiki/Q205692","display_name":"Poisson distribution","level":2,"score":0.29760000109672546},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.2962999939918518},{"id":"https://openalex.org/C45555294","wikidata":"https://www.wikidata.org/wiki/Q28113351","display_name":"Inequality","level":2,"score":0.29510000348091125},{"id":"https://openalex.org/C163175372","wikidata":"https://www.wikidata.org/wiki/Q3339222","display_name":"Linear model","level":2,"score":0.2808000147342682},{"id":"https://openalex.org/C205545832","wikidata":"https://www.wikidata.org/wiki/Q17156455","display_name":"Young adult","level":2,"score":0.2770000100135803},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.27489998936653137},{"id":"https://openalex.org/C48718317","wikidata":"https://www.wikidata.org/wiki/Q4691855","display_name":"Age adjustment","level":3,"score":0.26159998774528503},{"id":"https://openalex.org/C44249647","wikidata":"https://www.wikidata.org/wiki/Q208498","display_name":"Confidence interval","level":2,"score":0.25600001215934753},{"id":"https://openalex.org/C188321436","wikidata":"https://www.wikidata.org/wiki/Q1826488","display_name":"General linear model","level":3,"score":0.25519999861717224},{"id":"https://openalex.org/C64946054","wikidata":"https://www.wikidata.org/wiki/Q4874476","display_name":"Bayesian multivariate linear regression","level":3,"score":0.2533999979496002},{"id":"https://openalex.org/C20256973","wikidata":"https://www.wikidata.org/wiki/Q1050272","display_name":"Standard score","level":2,"score":0.2526000142097473},{"id":"https://openalex.org/C54183767","wikidata":"https://www.wikidata.org/wiki/Q10384","display_name":"Geriatrics","level":2,"score":0.2526000142097473},{"id":"https://openalex.org/C3019858935","wikidata":"https://www.wikidata.org/wiki/Q4340209","display_name":"Depressive symptoms","level":3,"score":0.25099998712539673},{"id":"https://openalex.org/C3017564526","wikidata":"https://www.wikidata.org/wiki/Q15854269","display_name":"Linear growth","level":2,"score":0.25049999356269836}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.21203/rs.3.rs-11011142/v1","doi":"https://doi.org/10.21203/rs.3.rs-11011142/v1","is_oa":true,"landing_page_url":"https://doi.org/10.21203/rs.3.rs-11011142/v1","pdf_url":"https://www.researchsquare.com/article/rs-11011142/latest.pdf","source":{"id":"https://openalex.org/S4306525896","display_name":"Research Square","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"Research Square","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.21203/rs.3.rs-11011142/v1","doi":"https://doi.org/10.21203/rs.3.rs-11011142/v1","is_oa":true,"landing_page_url":"https://doi.org/10.21203/rs.3.rs-11011142/v1","pdf_url":"https://www.researchsquare.com/article/rs-11011142/latest.pdf","source":{"id":"https://openalex.org/S4306525896","display_name":"Research Square","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"Research Square","raw_type":"posted-content"},"sustainable_development_goals":[{"score":1.0,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7225246902.pdf","grobid_xml":"https://content.openalex.org/works/W7225246902.grobid-xml"},"referenced_works_count":32,"referenced_works":["https://openalex.org/W1985366327","https://openalex.org/W2065826692","https://openalex.org/W2105092978","https://openalex.org/W2112669742","https://openalex.org/W2112778345","https://openalex.org/W2128573775","https://openalex.org/W2129700906","https://openalex.org/W3127371185","https://openalex.org/W3217582005","https://openalex.org/W4205239824","https://openalex.org/W4225308749","https://openalex.org/W4288426590","https://openalex.org/W4293561544","https://openalex.org/W4294185218","https://openalex.org/W4308891335","https://openalex.org/W4309774872","https://openalex.org/W4376132007","https://openalex.org/W4386882977","https://openalex.org/W4388164156","https://openalex.org/W4388976933","https://openalex.org/W4390064977","https://openalex.org/W4391164030","https://openalex.org/W4391232014","https://openalex.org/W4398264665","https://openalex.org/W4401012362","https://openalex.org/W4401382411","https://openalex.org/W4404886775","https://openalex.org/W4405586280","https://openalex.org/W4411874207","https://openalex.org/W7117254931","https://openalex.org/W7131799135","https://openalex.org/W7204230925"],"related_works":["https://openalex.org/W4410015595","https://openalex.org/W4413176326","https://openalex.org/W4391232014","https://openalex.org/W4211067606","https://openalex.org/W4401548118","https://openalex.org/W4416579337","https://openalex.org/W4385190256","https://openalex.org/W4322617091","https://openalex.org/W7152367377","https://openalex.org/W7148528466"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"Frailty":[2],"and":[3,10,13,38,59,65,70,91,102,129,169,196,260,283,313],"depressive":[4,284,314],"symptoms":[5,285,315],"often":[6],"coexist":[7],"in":[8,34,68,85,125,155,294],"middle-aged":[9],"older":[11],"adults":[12],"may":[14,316],"precede":[15],"increasing":[16,324],"multimorbidity":[17,36,296,325],"burden.":[18,297],"However,":[19],"it":[20],"remains":[21],"unclear":[22],"whether":[23,39,334],"different":[24],"frailty\u2013depressive":[25],"symptom":[26],"transition":[27,77],"patterns":[28,41],"are":[29,42,330],"associated":[30,287],"with":[31,106,116,160,237,288,305],"subsequent":[32,292,339],"changes":[33],"function-weighted":[35,295],"burden":[37],"high-risk":[40],"disproportionately":[43,301],"concentrated":[44,234,302],"among":[45,235,303],"socioeconomically":[46],"disadvantaged":[47],"groups.":[48],"Methods":[49],"We":[50],"used":[51],"four":[52],"waves":[53],"(2011\u20132018)":[54],"of":[55,212,227,266,281,311,323],"the":[56,86,151,170,187,224,228,270,289],"China":[57],"Health":[58],"Retirement":[60],"Longitudinal":[61],"Study.":[62],"Joint":[63,309],"frailty":[64,282,312],"depressive-symptom":[66],"states":[67],"2011":[69],"2013":[71],"were":[72,82,96,114,190],"grouped":[73],"into":[74],"seven":[75],"two-wave":[76],"patterns.":[78],"Outcomes":[79],"during":[80],"2013\u20132018":[81],"annualized":[83,156],"change":[84,158],"Chinese":[87],"multimorbidity-weighted":[88],"index":[89,242],"(CMWI)":[90],"upper-quartile":[92,130,140,175],"CMWI":[93,112,131,141,157,253],"growth.":[94,132,142],"Associations":[95,219],"estimated":[97,291],"using":[98],"multivariable":[99],"linear":[100,117],"regression":[101,105],"modified":[103],"Poisson":[104],"community-clustered":[107],"robust":[108],"standard":[109],"errors.":[110],"Repeated":[111],"measurements":[113],"examined":[115],"mixed-effects":[118],"models.":[119],"Concentration":[120],"indices":[121],"assessed":[122],"socioeconomic":[123,258,307],"inequalities":[124],"persistent":[126,147],"dual":[127,148,231],"vulnerability":[128,149,232],"Results":[133],"Among":[134],"8,133":[135],"participants,":[136],"2,016":[137],"(24.8%)":[138],"had":[139],"In":[143,182],"primary":[144],"Model":[145,185,202],"A,":[146],"showed":[150,255],"largest":[152,290],"mean":[153],"difference":[154,211],"compared":[159],"stable":[161],"low":[162],"risk":[163,172,210,322],"(0.203":[164],"points/year,":[165],"95%":[166,179,245],"CI":[167,180,194,200,217,246],"0.155\u20130.252)":[168],"highest":[171],"ratio":[173],"for":[174],"growth":[176,254],"(RR":[177],"2.15,":[178],"1.88\u20132.46).":[181],"secondary":[183],"baseline-conditional":[184],"B,":[186],"corresponding":[188],"estimates":[189],"0.271":[191],"points/year":[192],"(95%":[193,199,216],"0.222\u20130.321)":[195],"RR":[197],"2.19":[198],"1.91\u20132.51).":[201],"A":[203],"marginal":[204],"standardization":[205],"gave":[206],"an":[207],"adjusted":[208],"absolute":[209],"20.5":[213],"percentage":[214],"points":[215],"16.4\u201324.6).":[218],"remained":[220],"positive":[221],"after":[222],"excluding":[223],"mental-health-related":[225],"component":[226],"CMWI.":[229],"Persistent":[230,279],"was":[233,262,286,300],"participants":[236,304],"lower":[238,306],"household":[239],"consumption":[240],"(Erreygers":[241],"\u2212":[243,247,250],"0.0586,":[244],"0.0799":[248],"to":[249,332],"0.0387).":[251],"Upper-quartile":[252],"no":[256,263],"clear":[257,264],"concentration,":[259],"there":[261],"evidence":[265],"multiplicative":[267],"interaction":[268],"on":[269],"risk-ratio":[271],"scale":[272],"(joint":[273],"Wald":[274],"P":[275],"=":[276],"0.706).":[277],"Conclusions":[278],"co-occurrence":[280],"increase":[293],"This":[298],"pattern":[299],"status.":[308],"assessment":[310],"help":[317],"identify":[318],"individuals":[319],"at":[320],"higher":[321],"burden,":[326],"although":[327],"intervention":[328],"studies":[329],"needed":[331],"determine":[333],"targeted":[335],"management":[336],"can":[337],"improve":[338],"outcomes.":[340]},"counts_by_year":[],"updated_date":"2026-11-06T12:05:46.655746","created_date":"2026-11-05T00:00:00"}