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Article History

Received: 18 November 2025

Accepted: 4 May 2026

First Online: 11 May 2026

Declarations

:

: This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. As this research was a secondary analysis of publicly available, de-identified data from the National Health and Nutrition Examination Survey (NHANES), it did not involve direct interaction with human subjects. According to U.S. NHANES protocols, all participants in NHANES provided written informed consent at the time of data collection, and all NHANES procedures were approved by the National Center for Health Statistics (NCHS) Research Ethics Review Board (ERB). Therefore, additional ethical approval or individual consent for this secondary analysis was not required.

: National Center for Health Statistics (NCHS) Research Ethics Review Board, U.S. Centers for Disease Control and Prevention (CDC).

: All participants in NHANES provided written informed consent prior to participation. As the present study used only anonymized public NHANES datasets, no new consent was required.

: Human Ethics and Consent to Participate declarations: not applicable (secondary analysis of fully de-identified publicly available data).

: This study did not involve any interventional clinical trial.Clinical trial number: not applicable.

: The authors declare no competing interests.