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Article History

Received: 5 June 2024

Accepted: 23 May 2025

First Online: 26 June 2025

Declarations

:

: In terms of ethics approval, the Ethics Committee of the University of Bremen stated that studies based on GePaRD are exempt from institutional review board review. Apart from this, it is required to obtain approval from health insurance providers and their governmental authorities when using health insurance data for scientific purposes. The utilisation of health insurance data for scientific research is regulated by the Code of Social Law in Germany. All involved health insurance providers as well as the German Federal Office for Social Security and the Senator for Health, Women and Consumer Protection in Bremen as their responsible authorities approved the use of GePaRD data for this study. According to the § 75 of the Code of Social Law X, informed consent for studies based on health insurance data is required by law unless obtaining consent appears unacceptable and would bias results. For this study, the responsible authorities approved the use of the data without informed consent as informed consent was deemed to be unacceptable and to bias results.

: Not applicable.

: The authors declare no competing interests.