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Article History

Received: 1 July 2025

Accepted: 21 August 2025

First Online: 5 September 2025

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 patients/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.