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Every subject in this primary cohort signed a written consent form. The NHANES study protocols were approved by the Research Ethics Review Board of the National Center for Health Statistics (NCHS). Written informed consent was obtained from all participants prior to their inclusion in the study. Separately, the Clinical Research Ethics Committee at the China-Japan Friendship Hospital authorized the retrospective validation arm (No. 2024-KY-129-1). Given that this secondary analysis utilized anonymized data, the committee exempted the need for individual patient consent. Furthermore, this manuscript was prepared in strict compliance with the STROBE checklist for observational epidemiology.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"163"}}