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Article History

Received: 2 March 2026

Accepted: 2 July 2026

First Online: 17 July 2026

Declarations

Consent for publication: The submitted manuscript has been read and approved by all authors.

Competing interests: The authors declare no competing interests.

Ethics approval and consent to participant: This study utilized data from NHANES, which are publicly available and fully de-identified; therefore, institutional review board approval was not necessary as the work does not constitute human subjects research. The NHANES protocols had already been reviewed and approved by the National Center for Health Statistics (NCHS) Ethics Review Board, and all participants had provided written informed consent for both household interviews and health examinations as part of the standard NHANES procedures. Identifiable participant information is maintained securely by NCHS but is not accessible to the public. For the present analyses, additional consent was waived since only de-identified, publicly available NHANES data were used. Consistent with ethical standards and institutional regulations, the use of these data carries minimal participant risk and does not require further informed consent.