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Article History

Received: 11 December 2025

Accepted: 16 March 2026

First Online: 23 March 2026

Declarations

:

: All procedures performed in this study involving human data were conducted in accordance with the ethical standards of the responsible institutional and national research committees and with the 1964 Declaration of Helsinki and its later amendments. This study was based exclusively on de-identified electronic health record data obtained from the TriNetX Global Collaborative Network. The TriNetX platform provides access only to aggregated and de-identified patient data and operates in compliance with the de-identification standards defined in § 164.514(a) of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. The de-identification process has been formally certified by a qualified expert as specified in § 164.514(b)(1) of the HIPAA Privacy Rule. Because the analysis involved only anonymized secondary data and no direct interaction with human participants, the requirement for informed consent was waived. The Ethics Committee of the University of Lübeck confirmed that no additional ethical approval was required for this study design.

: Not applicable.

: The authors declare no competing interests.