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Article History

Received: 12 December 2025

Accepted: 2 June 2026

First Online: 26 June 2026

Declarations

:

: Xue Li received research grants or contracts from the Health and Medical Research Fund (HMRF) Main Scheme and HMRF Fellowship Scheme of the Hong Kong Special Administrative Region (SAR), China, and from the Research Grants Council Early Career Scheme, Research Impact Fund (Hong Kong SAR); was former nonexecutive director of Advanced Data Analytics for Medical Science Limited, Hong Kong SAR, China; received commission grants from Department of Health, Government of Hong Kong SAR, China; commission grants from Hospital Authority of Hong Kong SAR, China, internal funding from the University of Hong Kong, and research or education grants from Pfizer, Janssen and Bristol Myers Squibb (BMS), Novartis; received consultancy fees from Merck Sharp & Dohme, Pfizer, Open Health and The Office of Health Economics; and received honoraria for associate editorship from Nature Springer. None related to the work reported in the current manuscript. Nicole L. Pratt is an Editorial Board member of Drug Safety and was not involved in the selection of peer reviewers for the manuscript nor in any of the subsequent editorial decisions. Edward Chia‑Cheng Lai reports receiving research funding from Amgen, AbbVie, GW, IQVIA, J&J, MSD, Novartis, Pfizer, Prospection, Sanofi, and Taketa, outside the submitted work. Esther W.Y. Chan has received grants from Research Grants Council (RGC, HKSAR), Research Fund Secretariat of the Food and Health Bureau (Health and Medical Research Fund [HMRF], HKSAR), National Health and Medical Research Council (Australia), Narcotics Division of the Security Bureau of HKSAR, Innovation and Technology Commission of the Government of HKSAR, National Natural Science Fund of China, Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Eisai, Janssen, Pfizer, Takeda, and Novartis; and honorarium from Pfizer, Novartis, and the Hong Kong SAR Hospital Authority outside the submitted work. Kuan Peng, Vincent K.C. Yan, Shirley C.W. Chan, Ju-Young Shin and Chak-sing Lau have no conflicts of interest that are directly relevant to the content of this article.

: We thank Lisa Lam for proofreading this paper, and we thank Dr. Deliang Yang for providing statistical support during the analysis.

: The Enhanced Start-up Fund for new academic staff, LKS Faculty of Medicine, The University of Hong Kong, The University of Hong Kong Seed Fund for resubmission of General Research Fund, and the Internal Research Fund, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong provided funding for the preparation of this article.

: This study was performed in accordance with the Declaration of Helsinki (1964) and its subsequent amendments. Ethical approval for the research was granted by the Institutional Review Board of The University of Hong Kong Hospital Authority Hong Kong West Cluster under reference numbers UW 21-338. The institutional review board granted a waiver of informed patient consent. This was justified as the studies were exclusively observational, meaning no practical interventions were administered, and all patient-level data utilised were de-identified by the data custodian at the time of data extraction.

: Not applicable.

: Not applicable.

: The data supporting the findings of this study were obtained from the electronic health records database managed by the Hospital Authority of Hong Kong. Owing to data privacy regulations and licensing restrictions, the data cannot be shared publicly. Access to the data may be requested directly from the Hospital Authority of Hong Kong, subject to their approval and compliance with applicable regulations.

: The analytical code supporting this study is publicly available at .

: KP and VKCY performed the data analysis. KP, SCWC and XL conceptualised the study. KP and XL wrote the manuscript. SCWC, NLP, CSL, ECCL,CSL, JYS and EWYC contributed to the interpretation of results. XL supervised the study and obtained funding. All authors reviewed and approved the final manuscript.