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Article History

Received: 23 April 2025

Accepted: 21 October 2025

First Online: 12 November 2025

Declarations

:

: Not applicable. The NHANES data used in this analysis are publicly available and anonymized. This study utilized publicly available, de-identified data from the National Health and Nutrition Examination Survey (NHANES) 2011–2012, which is conducted by the Centers for Disease Control and Prevention (CDC). As this analysis does not involve human subjects directly and only uses secondary data, it was exempt from Institutional Review Board (IRB) approval. The National Center for Health Statistics (NCHS) Ethics Review Board (ERB) ensures protections of all human participants in NCHS studies and surveys. The NCHS ERB reviews and approves NHANES survey protocols. Approval of the current NHANES protocol and past protocols is documented on this page: .

: Not applicable. This study used publicly available secondary data (NHANES) and did not involve human subjects' research requiring individual consent.

: Not applicable.

: The author declares no competing interests.