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Article History

Received: 19 July 2025

Accepted: 25 August 2025

First Online: 30 October 2025

Declarations

:

: The authors declare no competing interests.

: This study utilized de-identified data obtained from the TriNetX database. The research was conducted in compliance with the ethical principles outlined in the Declaration of Helsinki and adhered to applicable legal and regulatory requirements. A waiver of informed consent was granted as the research involves no risk to participants, does not adversely affect their rights or welfare, and could not be practicably carried out without the waiver. The data used in this study was de-identified in accordance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR §164.514). The de-identification process was certified by a qualified expert, ensuring the confidentiality and privacy of all participants. This study was exempt from Institutional Review Board (IRB) oversight, as it involved the secondary analysis of pre-existing, de-identified data.

: As this study utilized de-identified data from the TriNetX database, a waiver of informed consent was obtained in accordance with ethical guidelines and regulatory requirements. The waiver was approved based on the following criteria: The research involves no more than minimal risk to participants. The waiver does not adversely affect the rights and welfare of participants. The research could not practicably be carried out without the waiver. The study does not involve direct interaction with participants, and all data is de-identified in compliance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR §164.514). As a result, no individual consent was required or sought for this research.