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Ethical approval was obtained in compliance with all applicable regulations and institutional requirements. All data utilized in this study were obtained from the National Health Insurance Research Database (NHIRD), authorized and regulated by the Ministry of Health and Welfare, Taiwan. The NHIRD may be linked with various public databases housed at the Data Science Center, including government surveys, disease registries, health surveys, social welfare reporting systems, and other administrative datasets. These datasets are linked through encrypted personal identification numbers using deterministic record linkage, ensuring both accuracy and confidentiality. To protect patient privacy, all reimbursement claims data were de-identified prior to analysis. 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