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Skin hyperextensibility is formally defined as the stretching of the skin over a standardized cut off in 3 of the following areas: 1.5 cm for the distal part of the forearms and the dorsum of the hands and 3 cm for neck, elbows, and knees [1, 7, 16, 17]

Initial state-level processing and column standardization: For each states raw dataset, we first performed initial cleaning, including handling missing values where appropriate and addressing inconsistencies in column naming conventions (e.g., case sensitivity, special characters)

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