{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T05:59:14Z","timestamp":1780984754796,"version":"3.54.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Rheumatol"],"published-print":{"date-parts":[[2026,6]]},"DOI":"10.1007\/s10067-026-08084-0","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T01:30:35Z","timestamp":1775007035000},"page":"3005-3017","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metformin use and risk of all-cause mortality in US adults with arthritis: a cohort study from NHANES 1999\u20132018"],"prefix":"10.1007","volume":"45","author":[{"given":"Ziqi","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaomin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1061-0491","authenticated-orcid":false,"given":"Li","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"8084_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2024.103202","volume":"145","author":"Z Kang","year":"2024","unstructured":"Kang Z, Zhang X, Du Y, Dai S-M (2024) Global and regional epidemiology of psoriatic arthritis in patients with psoriasis: a comprehensive systematic analysis and modelling study. J Autoimmun 145:103202. https:\/\/doi.org\/10.1016\/j.jaut.2024.103202","journal-title":"J Autoimmun"},{"key":"8084_CR2","doi-asserted-by":"publisher","first-page":"e594","DOI":"10.1016\/S2665-9913(23)00211-4","volume":"5","author":"GBD 2021 Rheumatoid Arthritis Collaborators","year":"2023","unstructured":"GBD 2021 Rheumatoid Arthritis Collaborators (2023) Global, regional, and national burden of rheumatoid arthritis, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 5:e594\u2013e610. https:\/\/doi.org\/10.1016\/S2665-9913(23)00211-4","journal-title":"Lancet Rheumatol"},{"key":"8084_CR3","doi-asserted-by":"publisher","first-page":"e508","DOI":"10.1016\/S2665-9913(23)00163-7","volume":"5","author":"GBD 2021 Osteoarthritis Collaborators","year":"2023","unstructured":"GBD 2021 Osteoarthritis Collaborators (2023) Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol 5:e508\u2013e522. https:\/\/doi.org\/10.1016\/S2665-9913(23)00163-7","journal-title":"Lancet Rheumatol"},{"key":"8084_CR4","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1622159","volume":"16","author":"H Huang","year":"2025","unstructured":"Huang H, Xie W, Geng Y, Fan Y, Zhang Z (2025) Mortality in patients with psoriatic arthritis: a systematic review and meta-analysis. Front Immunol 16:1622159. https:\/\/doi.org\/10.3389\/fimmu.2025.1622159","journal-title":"Front Immunol"},{"key":"8084_CR5","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1007\/s00393-024-01538-3","volume":"83","author":"YH Lee","year":"2024","unstructured":"Lee YH, Song GG (2024) All-cause and cause-specific mortality in rheumatoid arthritis: a meta-analysis. Z Rheumatol 83:314\u2013320. https:\/\/doi.org\/10.1007\/s00393-024-01538-3","journal-title":"Z Rheumatol"},{"key":"8084_CR6","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.semarthrit.2016.04.002","volume":"46","author":"N Veronese","year":"2016","unstructured":"Veronese N, Cereda E, Maggi S, Luchini C, Solmi M, Smith T, Denkinger M, Hurley M, Thompson T, Manzato E, Sergi G, Stubbs B (2016) Osteoarthritis and mortality: a prospective cohort study and systematic review with meta-analysis. Semin Arthritis Rheum 46:160\u2013167. https:\/\/doi.org\/10.1016\/j.semarthrit.2016.04.002","journal-title":"Semin Arthritis Rheum"},{"key":"8084_CR7","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1136\/ard-2024-225696","volume":"83","author":"HL Pisaniello","year":"2024","unstructured":"Pisaniello HL, Lester SE, Russell O, Black R, Tieu J, Richards B, Barrett C, Lassere M, March L, Buchbinder R, Hill C, Whittle SL (2024) The associations between poorer pain-related health status and increased hospitalisations and excess mortality in patients with rheumatoid arthritis (RA): a prospective cohort analysis using the Australian Rheumatology Association Database (ARAD). Ann Rheum Dis 83:1400\u20131402. https:\/\/doi.org\/10.1136\/ard-2024-225696","journal-title":"Ann Rheum Dis"},{"key":"8084_CR8","doi-asserted-by":"publisher","first-page":"3592","DOI":"10.1093\/rheumatology\/kead038","volume":"62","author":"M Pineda-Moncus\u00ed","year":"2023","unstructured":"Pineda-Moncus\u00ed M, Dernie F, Dell\u2019Isola A, Kamps A, Runhaar J, Swain S, Zhang W, Englund M, Pitsillidou I, Strauss VY, Robinson DE, Prieto-Alhambra D, Khalid S (2023) Classification of patients with osteoarthritis through clusters of comorbidities using 633\u200a330 individuals from Spain. Rheumatology (Oxford) 62:3592\u20133600. https:\/\/doi.org\/10.1093\/rheumatology\/kead038","journal-title":"Rheumatology (Oxford)"},{"key":"8084_CR9","doi-asserted-by":"publisher","DOI":"10.1007\/s13346-025-01903-y","author":"NA Sulong","year":"2025","unstructured":"Sulong NA, Lee VS, Fei CC, Johan MR (2025) Exploring multifaceted roles of metformin in therapeutic applications, mechanistic insights, and innovations in drug delivery systems across biological contexts: a systematic review. Drug Deliv Transl Res. https:\/\/doi.org\/10.1007\/s13346-025-01903-y","journal-title":"Drug Deliv Transl Res"},{"issue":"25","key":"8084_CR10","doi-asserted-by":"publisher","first-page":"00218","DOI":"10.1016\/j.jare.2025.03.058","volume":"S2090\u20131232","author":"X Li","year":"2025","unstructured":"Li X, Xiang Z, Wang X, He H, Xu M, Tan C, Wu X, Zhang J, Dong W (2025) Metformin attenuates colitis via blocking STAT3 acetylation by reducing acetyl-CoA production. J Adv Res S2090\u20131232(25):00218\u201300228. https:\/\/doi.org\/10.1016\/j.jare.2025.03.058","journal-title":"J Adv Res"},{"key":"8084_CR11","doi-asserted-by":"publisher","DOI":"10.1038\/s41392-022-01232-3","volume":"8","author":"H Liu","year":"2023","unstructured":"Liu H, Duan C, Yang X, Liu J, Deng Y, Tiselius H-G, Ye Z, Wang T, Xing J, Xu H (2023) Metformin suppresses calcium oxalate crystal-induced kidney injury by promoting Sirt1 and M2 macrophage-mediated anti-inflammatory activation. Signal Transduct Target Ther 8:38. https:\/\/doi.org\/10.1038\/s41392-022-01232-3","journal-title":"Signal Transduct Target Ther"},{"key":"8084_CR12","doi-asserted-by":"publisher","first-page":"9376","DOI":"10.7150\/thno.64706","volume":"11","author":"Y Ding","year":"2021","unstructured":"Ding Y, Zhou Y, Ling P, Feng X, Luo S, Zheng X, Little PJ, Xu S, Weng J (2021) Metformin in cardiovascular diabetology: a focused review of its impact on endothelial function. Theranostics 11:9376\u20139396. https:\/\/doi.org\/10.7150\/thno.64706","journal-title":"Theranostics"},{"key":"8084_CR13","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1007\/s12020-024-04012-x","volume":"87","author":"B Zhang","year":"2025","unstructured":"Zhang B, Cao Y, Qu Z, Sun Y, Tian X (2025) The impact of metformin on mortality in patients with type 2 diabetes mellitus: a prospective cohort study. Endocrine 87:136\u2013143. https:\/\/doi.org\/10.1007\/s12020-024-04012-x","journal-title":"Endocrine"},{"key":"8084_CR14","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1186\/s12916-024-03484-y","volume":"22","author":"Y Li","year":"2024","unstructured":"Li Y, Liu X, Lv W, Wang X, Du Z, Liu X, Meng F, Jin S, Wen S, Bai R, Liu N, Tang R (2024) Metformin use correlated with lower risk of cardiometabolic diseases and related mortality among US cancer survivors: evidence from a nationally representative cohort study. BMC Med 22:269. https:\/\/doi.org\/10.1186\/s12916-024-03484-y","journal-title":"BMC Med"},{"key":"8084_CR15","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1016\/j.numecd.2020.11.031","volume":"31","author":"M Monami","year":"2021","unstructured":"Monami M, Candido R, Pintaudi B, Targher G, Mannucci E (2021) Effect of metformin on all-cause mortality and major adverse cardiovascular events: an updated meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis 31:699\u2013704. https:\/\/doi.org\/10.1016\/j.numecd.2020.11.031","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"8084_CR16","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.641635","volume":"12","author":"C-Y Lin","year":"2021","unstructured":"Lin C-Y, Wu C-H, Hsu C-Y, Chen T-H, Lin M-S, Lin Y-S, Su Y-J (2021) Reduced mortality associated with the use of metformin among patients with autoimmune diseases. Front Endocrinol (Lausanne) 12:641635. https:\/\/doi.org\/10.3389\/fendo.2021.641635","journal-title":"Front Endocrinol (Lausanne)"},{"key":"8084_CR17","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.559446","volume":"11","author":"Y Hu","year":"2020","unstructured":"Hu Y, Lei M, Ke G, Huang X, Peng X, Zhong L, Fu P (2020) Metformin use and risk of all-cause mortality and cardiovascular events in patients with chronic kidney disease-a systematic review and meta-analysis. Front Endocrinol (Lausanne) 11:559446. https:\/\/doi.org\/10.3389\/fendo.2020.559446","journal-title":"Front Endocrinol (Lausanne)"},{"key":"8084_CR18","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-019-0900-7","volume":"18","author":"Y Han","year":"2019","unstructured":"Han Y, Xie H, Liu Y, Gao P, Yang X, Shen Z (2019) Effect of metformin on all-cause and cardiovascular mortality in patients with coronary artery diseases: a systematic review and an updated meta-analysis. Cardiovasc Diabetol 18:96. https:\/\/doi.org\/10.1186\/s12933-019-0900-7","journal-title":"Cardiovasc Diabetol"},{"key":"8084_CR19","doi-asserted-by":"publisher","first-page":"1804","DOI":"10.1001\/jama.2025.3471","volume":"333","author":"F Pan","year":"2025","unstructured":"Pan F, Wang Y, Lim YZ, Urquhart DM, Estee MM, Wluka AE, Wolfe R, Cicuttini FM (2025) Metformin for knee osteoarthritis in patients with overweight or obesity: a randomized clinical trial. JAMA 333:1804\u20131812. https:\/\/doi.org\/10.1001\/jama.2025.3471","journal-title":"JAMA"},{"key":"8084_CR20","doi-asserted-by":"publisher","first-page":"2349","DOI":"10.1007\/s10787-024-01495-y","volume":"32","author":"AAE Aiad","year":"2024","unstructured":"Aiad AAE, El-Haggar SM, El-Barbary AM, El-Afify DR (2024) Metformin as adjuvant therapy in obese knee osteoarthritis patients. Inflammopharmacology 32:2349\u20132359. https:\/\/doi.org\/10.1007\/s10787-024-01495-y","journal-title":"Inflammopharmacology"},{"key":"8084_CR21","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.726490","volume":"12","author":"M Gharib","year":"2021","unstructured":"Gharib M, Elbaz W, Darweesh E, Sabri NA, Shawki MA (2021) Efficacy and safety of metformin use in rheumatoid arthritis: a randomized controlled study. Front Pharmacol 12:726490. https:\/\/doi.org\/10.3389\/fphar.2021.726490","journal-title":"Front Pharmacol"},{"key":"8084_CR22","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2021.107575","volume":"95","author":"MS Abdallah","year":"2021","unstructured":"Abdallah MS, Alarfaj SJ, Saif DS, EL-Naggar ME, Elsokary MA, Elsawah HK, Abdelsattar Zaki S, Wahsh EA, Abo Mansour HE, Mosalam EM (2021) The AMPK modulator metformin as adjunct to methotrexate in patients with rheumatoid arthritis: a proof-of-concept, randomized, double-blind, placebo-controlled trial. Int Immunopharmacol 95:107575. https:\/\/doi.org\/10.1016\/j.intimp.2021.107575","journal-title":"Int Immunopharmacol"},{"key":"8084_CR23","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-019-1915-x","volume":"21","author":"Y Wang","year":"2019","unstructured":"Wang Y, Hussain SM, Wluka AE, Lim YZ, Abram F, Pelletier J-P, Martel-Pelletier J, Cicuttini FM (2019) Association between metformin use and disease progression in obese people with knee osteoarthritis: data from the Osteoarthritis Initiative-a prospective cohort study. Arthritis Res Ther 21:127. https:\/\/doi.org\/10.1186\/s13075-019-1915-x","journal-title":"Arthritis Res Ther"},{"key":"8084_CR24","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1007\/s10067-025-07337-8","volume":"44","author":"J Wang","year":"2025","unstructured":"Wang J, Gao F, Liu C, Wang F (2025) Association of folate levels with all-cause and cause-specific mortality in patients with arthritis. Clin Rheumatol 44:953\u2013968. https:\/\/doi.org\/10.1007\/s10067-025-07337-8","journal-title":"Clin Rheumatol"},{"key":"8084_CR25","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1186\/s13075-024-03410-w","volume":"26","author":"Q Che","year":"2025","unstructured":"Che Q, Jia Q, Zhang X, Sun S, Zhang X, Shu Q, Zhang Y, Chen G, Huang A, Hu Y, Fu C, Cai M, Wu X, Jin H, Li Z, Li Y, Chen Z, Zhu Y, Wang Y-Z, Chen Y, Guo J, Wang Z-Z (2025) Cardiovascular health metrics and all-cause mortality in osteoarthritis, inflammatory arthritis, and unclassified arthritis patients: a national prospective cohort study. Arthritis Res Ther 26:179. https:\/\/doi.org\/10.1186\/s13075-024-03410-w","journal-title":"Arthritis Res Ther"},{"key":"8084_CR26","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1007\/s11606-019-05398-5","volume":"35","author":"C Liu","year":"2020","unstructured":"Liu C, Foti K, Grams ME, Shin J-I, Selvin E (2020) Trends in self-reported prediabetes and metformin use in the USA: NHANES 2005\u20132014. J Gen Intern Med 35:95\u2013101. https:\/\/doi.org\/10.1007\/s11606-019-05398-5","journal-title":"J Gen Intern Med"},{"key":"8084_CR27","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.canep.2012.08.007","volume":"37","author":"CJ Johnson","year":"2013","unstructured":"Johnson CJ, Weir HK, Fink AK, German RR, Finch JL, Rycroft RK, Yin D (2013) The impact of National Death Index linkages on population-based cancer survival rates in the United States. Cancer Epidemiol 37:20\u201328. https:\/\/doi.org\/10.1016\/j.canep.2012.08.007","journal-title":"Cancer Epidemiol"},{"key":"8084_CR28","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1444800","volume":"15","author":"Y Zhou","year":"2024","unstructured":"Zhou Y, Gao J (2024) Association between metabolic score for insulin resistance and cardiovascular disease mortality in patients with rheumatoid arthritis: evidence from the NHANES 1999-2018. Front Endocrinol (Lausanne) 15:1444800. https:\/\/doi.org\/10.3389\/fendo.2024.1444800","journal-title":"Front Endocrinol (Lausanne)"},{"key":"8084_CR29","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g14","volume":"348","author":"VWV Jaddoe","year":"2014","unstructured":"Jaddoe VWV, de Jonge LL, Hofman A, Franco OH, Steegers EAP, Gaillard R (2014) First trimester fetal growth restriction and cardiovascular risk factors in school age children: population based cohort study. BMJ 348:g14\u2013g14. https:\/\/doi.org\/10.1136\/bmj.g14","journal-title":"BMJ"},{"key":"8084_CR30","doi-asserted-by":"publisher","first-page":"2411","DOI":"10.1056\/NEJMoa2012410","volume":"382","author":"J Geleris","year":"2020","unstructured":"Geleris J, Sun Y, Platt J, Zucker J, Baldwin M, Hripcsak G, Labella A, Manson DK, Kubin C, Barr RG, Sobieszczyk ME, Schluger NW (2020) Observational study of hydroxychloroquine in hospitalized patients with COVID-19. N Engl J Med 382:2411\u20132418","journal-title":"N Engl J Med"},{"key":"8084_CR31","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000043987","volume":"104","author":"F Zhou","year":"2025","unstructured":"Zhou F, Dong Y, Yu L, Chen S, Tan L (2025) Association between prior hospitalization and nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) in community-dwelling U.S. adults: evidence from NHANES. Medicine (Baltimore) 104:e43987. https:\/\/doi.org\/10.1097\/MD.0000000000043987","journal-title":"Medicine (Baltimore)"},{"key":"8084_CR32","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1080\/00273171.2011.568786","volume":"46","author":"PC Austin","year":"2011","unstructured":"Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399\u2013424. https:\/\/doi.org\/10.1080\/00273171.2011.568786","journal-title":"Multivar Behav Res"},{"key":"8084_CR33","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1001\/jama.2018.21554","volume":"321","author":"S Haneuse","year":"2019","unstructured":"Haneuse S, VanderWeele TJ, Arterburn D (2019) Using the e-value to assess the potential effect of unmeasured confounding in observational studies. JAMA 321:602. https:\/\/doi.org\/10.1001\/jama.2018.21554","journal-title":"JAMA"},{"key":"8084_CR34","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1016\/j.ard.2025.04.011","volume":"84","author":"N Steinz","year":"2025","unstructured":"Steinz N, Maarseveen TD, van den Akker EB, Cope AP, Isaacs JD, Winkler AR, Huizinga TWJ, Abraham Y, Knevel R (2025) Time-independent disease state identification defines distinct trajectories determined by localised vs systemic inflammation in patients with early rheumatoid arthritis. Ann Rheum Dis 84:1301\u20131312. https:\/\/doi.org\/10.1016\/j.ard.2025.04.011","journal-title":"Ann Rheum Dis"},{"key":"8084_CR35","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1093\/eurheartj\/ehw208","volume":"38","author":"PE Lazzerini","year":"2017","unstructured":"Lazzerini PE, Capecchi PL, Laghi-Pasini F (2017) Systemic inflammation and arrhythmic risk: lessons from rheumatoid arthritis. Eur Heart J 38:1717\u20131727. https:\/\/doi.org\/10.1093\/eurheartj\/ehw208","journal-title":"Eur Heart J"},{"key":"8084_CR36","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijbiomac.2025.144482","volume":"315","author":"ME El-Haddad","year":"2025","unstructured":"El-Haddad ME, El-Refaie WM, Hammad GO, El-Massik MA (2025) Intra-articular metformin-curcumin cationic PLGA nanoparticles rejuvenate articular structure in MIA induced osteoarthritis model via modulating the crosstalk between miR93, TNFAIP3\/TLR\/NF-\u03baB and AMPK\/SIRT1 trajectories. Int J Biol Macromol 315:144482. https:\/\/doi.org\/10.1016\/j.ijbiomac.2025.144482","journal-title":"Int J Biol Macromol"},{"key":"8084_CR37","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-024-04859-9","volume":"24","author":"F Qiu","year":"2024","unstructured":"Qiu F, Li J, Gan L, Legerlotz K (2024) Arthritis prevalence is associated with metabolic syndrome risk factors but not with physical activity in middle-aged and older patients - a cross-sectional study. BMC Geriatr 24:242. https:\/\/doi.org\/10.1186\/s12877-024-04859-9","journal-title":"BMC Geriatr"}],"container-title":["Clinical Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10067-026-08084-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10067-026-08084-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10067-026-08084-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T05:24:51Z","timestamp":1780982691000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10067-026-08084-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":37,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["8084"],"URL":"https:\/\/doi.org\/10.1007\/s10067-026-08084-0","relation":{},"ISSN":["0770-3198","1434-9949"],"issn-type":[{"value":"0770-3198","type":"print"},{"value":"1434-9949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"assertion":[{"value":"24 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 January 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The original NHANES study received approval from the NCHS Research Ethics Review Board with informed consent obtained from all participants. The anonymized data is publicly accessible for research purposes following established usage guidelines. Therefore, additional institutional ethics approval was not required for this secondary data analysis, consistent with standard practices for studies using publicly available, de-identified datasets. We strictly adhered to NHANES data usage policies, anonymization protocols, and Declaration of Helsinki principles throughout this statistical analysis.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors have reviewed and approved the manuscript for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}