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Article History

Received: 4 April 2025

Accepted: 8 August 2025

First Online: 29 September 2025

Declarations

:

: This study used anonymized, aggregated county-level data obtained from the Health Information System platform. The dataset contained no individual-level identifiers or personal health information. As the study involved secondary analysis of de-identified, routinely collected health data without interaction with human subjects, ethics approval and informed consent were not required. This approach is consistent with institutional and national data protection guidelines and adheres to the ethical principles outlined in the Declaration of Helsinki for research involving minimal risk and non-identifiable data.

: Not applicable.

: The authors declare no competing interests.