highly significantp < 0.01
Upon age stratification, the <40 years group and the ≥40 years group exhibited markedly different mean score distributions ( Figure 1 ): the <40 years group mean was 3.87 ± 0.15, and the ≥40 years group mean was 2.28 ± 0.21, with Welch’s t -test confirming the difference was highly significant (t = 47.46, p < 0.01).