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TriNetX is a global federated health research network providing access to EMRs from HCOs worldwide. Research studies utilising TriNetX do not require ethical approval as part of a federated network. Participating HCOs\u2019 identities to each dataset are kept confidential, adhering to ethical norms and regulatory frameworks that prevent data re-identification. The TriNetX platform uses only aggregated counts and statistical summaries of deidentified information. No Protected Health Information or personal data is accessible to platform users. All data collection, processing, and transmission comply with applicable Data Protection laws for the contributing HCOs, including the EU Data Protection Law Regulation 2016\/679, the General Data Protection Regulation regarding the protection of individuals in relation to personal data processing, and the Health Insurance Portability and Accountability Act (HIPAA), the US federal law protecting the privacy and security of healthcare data. Individual personal data does not leave the HCO. TriNetX is ISO\/IEC 27001: 2022 certified and maintains a robust IT security program to protect personal and healthcare data. This retrospective study is exempt from informed consent. The data reviewed constitutes a secondary analysis of existing data and does not involve intervention or interaction with human subjects, and it is deidentified per the deidentification standard defined in Section \u00a7 164. 514 (a) of the HIPAA Privacy Rule. The process of deidentifying the data is validated through a formal determination by a qualified expert as outlined in Section \u00a7 164. 514 (b) (1) of the HIPAA Privacy Rule, with this determination refreshed in December 2020. 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