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This study did not involve human participants, human cell or tissue samples, or animals. All analyses were performed using publicly available, fully de-identified, aggregate data from the Centers for Medicare & Medicaid Services, the U.S. Census Bureau, and the UCSF Health Atlas. Because the study did not constitute human subjects research, it did not require Institutional Review Board review or approval, and the requirement for informed consent is not applicable. All methods were carried out in accordance with relevant guidelines and regulations.","order":1,"name":"Ethics","label":"Ethics and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. 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