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Article History

Received: 14 September 2025

Accepted: 9 January 2026

First Online: 20 January 2026

Declarations

:

: The NCHS Research Ethics Review Committee and the NHANES both examined and approved the research that involved human subjects. To take part in this study, the participants gave their written informed consent. This study utilized de-identified, publicly available NHANES secondary data. All personally identifiable information (including names, identification numbers, and other direct identifiers) was removed through standardized de-identification procedures in compliance with ethical requirements for human subject data protection. In accordance with prevailing research ethics guidelines, secondary analysis of such pre-approved, de-identified public datasets qualifies for exemption from additional institutional review, a standard this study rigorously followed.

: Not applicable.

: The authors declare no competing interests.