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Article History

Received: 29 August 2024

Revised: 2 December 2025

Accepted: 4 December 2025

First Online: 16 December 2025

Declarations

:

: This study used publicly available and de-identified data from the National Health and Nutrition Examination Survey (NHANES). All NHANES procedures were reviewed and approved by the National Center for Health Statistics (NCHS) Ethics Review Board. The survey cycles included in this study (2013–2020) received ethical approval under ERB Protocol #2011–17 and ERB Protocol #2018–01. All participants provided written informed consent at the time of data collection. The present analysis involved secondary use of de-identified data and was therefore exempt from additional institutional review board (IRB) approval. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki (1964) and its later amendments.

: Not applicable.

: The authors report no conflict of interest.