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Article History

Received: 29 October 2025

Revised: 1 February 2026

Accepted: 16 February 2026

First Online: 21 April 2026

Competing interests

: The authors declare no competing interests.

: This research is based on an analysis of publicly available data from NHANES, obtained with approval from the Ethics Review Board of the National Center for Health Statistics ( ). Since the NHANES public use datasets do not include any personally identifiable information, the requirement for ethical review and approval was waived for this study. All procedures were performed in compliance with the World Medical Association Declaration of Helsinki. All participants provided informed consent before their involvement in the study.