Reporting racial and ethnic diversity in eating disorder research over the past 20 years

Abstract

Objective:

Recent public awareness of racial and ethnic disparities has again brought to light issues of diversity, equity, and inclusion in the eating disorders field. However, empirical information on racial and ethnic representation in eating disorders research is limited, making it difficult to understand where improvements are needed.

Method:

This study reviewed all studies including human participants published in the International Journal of Eating Disorders in 2000, 2010, and 2020. Differences in likelihood of reporting race and ethnicity were calculated based on study year, location, and diagnostic categories.

Results:

Out of 377 manuscripts, 45.2% reported information on the race and ethnicity of study participants. Studies conducted in the United States were more likely to report (128/173), and those conducted in Europe were less likely to report (5/61) on race and ethnicity than those conducted outside of those regions. Rates of reporting increased from 2000 to 2020. White participants made up approximately 70% of the samples that reported race and ethnicity data. Hispanic participants made up approximately 10% of samples reporting race and ethnicity. Participants from all other races and ethnicities made up less than 5% each.

Discussion:

Although rates of reporting race and ethnicity increased over time, most participants were White. Rates of reporting also differed by the geographical region, which may reflect variability in how information on race and ethnicity is collected across countries. More attention toward capturing the cultural background of research participants and more inclusivity in research are needed in the eating disorders field.

1 |. INTRODUCTION

The eating disorders field has engaged in serious self-reflection with the aim of increasing racial and ethnic diversity, equity, and inclusion (DEI). Over the past 30 years, researchers have expressed the importance of identifying cultural features that may differentiate eating disorders in different racial and ethnic groups (Rodgers, Berry, & Franko, 2018; Root, 1990; Smolak & Striegel-Moore, 2001). However, studies focusing on racial and ethnic minority individuals, in particular, Black and Indigenous (i.e., individuals who are descendants of the earliest known inhabitants of a region) populations that have been historically marginalized, represent only a small proportion of eating disorders research (Mikhail & Klump, 2021). Although it is widely acknowledged that eating disorders do not only affect White women of European descent, overall rates of reporting and inclusion of racial and ethnic diversity in eating disorders research are unclear, making it difficult to understand where improvements should be made.

Race and ethnicity are indistinct social constructs with classifications that have shifted over time. Race can be thought of as a symbolic category constructed within specific historical and social constructs and meant to capture phenotypical or ancestral differences (Desmond & Emirbayer, 2009), whereas ethnicity has historically referred to cultural identity, such a common language, customs, and religion (Flanagin, Frey, Christiansen, & AMA Manual of Style Committee, 2021). Both race and ethnicity vary by cultural context and do not have concrete categories (Smedley, 1998), which has likely contributed to the lack of their systematic reporting in the eating disorders literature. The two constructs may also be seen as overlapping, as is reflected in the United Nations recommendations on statistical data collection on ethnicity, which states, “Ethnicity can be measured using a variety of concepts, including ethnic ancestry or origin, ethnic identity, cultural origins, nationality, race, colour, minority status, tribe, language, religion or various combinations of these concepts” (United Nations Department of Economic and Social Affairs, 2017, p. 205). In one study, Hamer et al. (2020) explored the understanding of the term “ethnic group” among 273 university students from four countries and found differences in their understanding of the term based on country. Specifically, most United States participants understood ethnic group as “race”; most British students understood ethnic group as “culture”; most Mexican participants understood ethnic group as “culture,” “language,” and “physical features/looks”; and most Polish participants understood ethnic group as “nation” and “language.” This study supports the notion that there is not a global understanding of the term “ethnicity” (or ethnic group), and the term is highly based on a country’s ethnocultural and historical context as well as official groupings used by national censuses.

Adding to the complexity of defining race and ethnicity, there is debate about how and whether such data should be collected. In the United States, information on race and ethnicity is routinely collected, and research that receives federal funding is often required to report race and ethnicity of participants and to include appropriately diverse samples (NIH, 2021a, 2021b). In contrast, countries in the European Union are unlikely to include race or racial origin in national data collection efforts (Farkas, 2017), and, if such information is collected, are more likely to inquire about ethnicity, immigration status, or place of birth (Parameshwaran & Engzell, 2015). Some countries, such as France and Germany, are known for their “colorblind” approaches to race and ethnicity and have not regularly collected this data since World War II (Simon, 2007; Simon & Piché, 2012). Although these practices have recently come under fire from advocates urging for more transparency and recognition of racial injustice, they are largely in place to protect people who have been historically discriminated against, excluded, and profiled from potentially being further persecuted as a result of characteristics reported in statistics (Simon, 2007). Nevertheless, lack of collection of race and ethnicity data makes it difficult to understand racial and ethnic differences and similarities in eating disorder etiology, presentation, treatment, especially on an international level.

Prior research examining DSM-5 eating disorders among racial and ethnic groups in the United States has found that prevalence estimates of lifetime anorexia nervosa (AN) are lower in Hispanic individuals than White individuals, and prevalence estimates of both lifetime AN and binge-eating disorder (BED) are lower in non-Hispanic Black individuals than White individuals (Udo & Grilo, 2018). Prevalence estimates of eating disorders in other racial and ethnic minority groups are less clear (Udo & Grilo, 2018). However, it is impossible to improve prevalence data on the presentation of eating disorders in racial and ethnic minority groups if our research does not report demographics of the study samples.

Across areas of psychology, only 5% of all articles from 1970 to 2010 explicitly mentioned race, looked at outcomes based on race, or had samples entirely composed of racial minority individuals (Roberts, Bareket-Shavit, Dollins, Goldie, & Mortenson, 2020). Within eating disorders, Mikhail and Klump (2021) found that only 2.5% of articles published in the International Journal of Eating Disorders (IJED) from 1981 to 2020 had a primary focus on Black or Indigenous individuals or examined how disordered eating might differ between Black or Indigenous individuals and individuals from other races or ethnicities. These data indicate that the vast majority of research is not specifically focused on racial and ethnic minorities. As such, it is important to understand how race and ethnicity are reported in studies without this focus, and what the racial and ethnic composition of study samples may be. In addition, the inclusion of diverse samples in eating disorder research is critical given the lack of identification of eating disorders in individuals who do not identify as White, the inadequate treatment that these groups receive, and the lack of understanding of how cultural factors may contribute to the development and maintenance of eating disorders in these populations (Marques et al., 2011; Pike & Dunne, 2015; Sonneville & Lipson, 2018; Waller et al., 2009).

The purpose of the present study was twofold. First, we aimed to assess rates of reporting race and ethnicity in a selected sample of studies published in IJED over the past 20 years (in years 2000, 2010, 2020) and, given differences in the treatment of race and ethnicity by country, to assess whether this differed by location of study. Second, we aimed to assess the racial and ethnic composition of participants included in these studies to examine overall racial and ethnic diversity and representation. IJED was chosen because it has global readership and authorship. It was ranked as the top eating disorder journal in psychology (21/131) by Clarivate Analytics citation reports and is linked to the Academy for Eating Disorders (AED), a global professional association committed to leadership in eating disorders with all AED members receiving an IJED subscription. We expected that reporting race and ethnicity would increase over the course of the 20-year period, that studies conducted in the United States would be more likely to report race and ethnicity than those conducted outside of the United States, and that most research participants would be White.

2 |. METHOD

2.1 |. Eligibility criteria

Consistent with methods from previous studies (Reardon, Smack, Herzhoff, & Tackett, 2019), we selected a sample of articles published in IJED over the past 20 years, including the years 2000, 2010, and 2020. Those that included data collected from human participants were included in the current review, except for review articles and meta-analyses.

2.2 |. Study selection

See Figure 1 for screening and selection of articles. First, the title and abstract of each article were independently screened by at least one author to identify publications that involved data collection with human participants. Second, the full text of each abstract that met criteria was independently reviewed by two authors as a second check to ensure that inclusion criteria were met. Interrater reliability ranged from .71 (title and abstract screening) to .90 (full-text screening) (Cohen’s κ). Differing opinions among raters were discussed to reach a consensus. All discrepancies reflected either human error or difficulty identifying whether human participants were included in the research based on the abstract.

FIGURE 1.

Flowchart of included articles

2.3 |. Data extraction

Data from articles that met inclusion criteria were independently extracted by two authors. For each article, information on article title, publication year, geographical location of study, study design, total sample size, race, ethnicity, and eating disorder diagnosis were collected. Any disagreements at the extraction phase were resolved by the first author (A.E.) or last author (K.J.M.).

2.4 |. Classification of race and ethnicity

Given that there is no international classification system of race or ethnicity, we based our racial and ethnic categories on the U.S. Census data (U.S. Census Bureau, 2019) as well as additional categories that arose during the data extraction process. This included the addition of a “Middle Eastern” category to capture individuals from the Middle East (e.g., Palestine, Iran, Saudi Arabia, and Israel; category collapsed due to small number of studies from each country), and an Indigenous category to capture individuals outside of the United States who were native to countries that are now dominated by individuals from Western European descent (e.g., Australia, New Zealand). Individuals from the United States who fell into the Indigenous category were categorized as American Indian/Alaska Native, consistent with the U.S. Census. We also separated individuals of Asian descent into those from the eastern or southeastern portion of Asia (e.g., China, Japan, Korea) and those from the southern portion of Asia (e.g., India, Sri Lanka, Pakistan). Although the U.S. Census classifies “Hispanic/Latino” as an ethnicity and not a race, and then further asks what race a person of this ethnicity considers themselves, reporting of Hispanic/Latinx participants was inconsistent across studies; therefore, we counted participants who were classified as Hispanic/Latinx as such regardless of whether they provided additional information about race. Finally, we classified participants who identified as either White or Caucasian as White and those who identified as being of African descent as Black. Studies that only reported on where a participant was born, but did not give information about cultural background, or that reported having a “majority” of participants from a certain race/ethnicity, were considered not to have reported race and ethnicity.

2.5 |. Statistical analysis

SPSS version 25 (IBM Corporation) was used for statistical analyses. Descriptive statistics and frequency tables were used to calculate percentages, means, and standard deviations. Racial and ethnic breakdown was calculated in two ways. First, averages were calculated across samples that included any participants with the listed racial/ethnic identity by weighting cases with respect to the number of participants included in each study. Second, the percentage of participants of each race/ethnicity were calculated out of the total number of participants whose race/ethnicity could be identified across all examined articles. χ² analyses were used to determine differences in change over time in the reporting of race/ethnicity and differences in reporting race/ethnicity by whether the study was conducted in the United States or another country and whether the study was conducted in Europe or another country. Number needed to take (NNT) was calculated for analyses of proportional differences between groups as a measure of effect size. Given the discrepancies in reporting of race and ethnicity across the literature, and as some studies allowed participants to select more than one race or choose not to disclose race, percentages do not add up to 100.

3 |. RESULTS

A total of 377 studies were included in the analysis. Approximately 31% of papers were published in 2000, 26% in 2010, and 43% in 2020, consistent with the increase in the total number of papers published in IJED from 2000 to 2020 (Ns = 106, 122, 213, respectively). Most studies were conducted in the United States (45.9%), Europe or the United Kingdom (26.8%), and Australia, New Zealand, or Fiji (10.9%). See Table 1 for full breakdown by country.

TABLE 1.

Studies included for review classified by country or region

Country	n (%)
USA	173 (45.9)
Europe	61 (16.2)
Australia/New Zealand/Fiji	41 (10.9)
United Kingdom	40 (10.6)
Canada	16 (4.2)
Middle East	9 (2.4)
Multiple other	8 (2.1)
Unspecified/other	7 (1.9)
Multiple Western countries	7 (1.9)
China/Taiwan/Hong Kong	6 (1.6)
Japan	5 (1.3)
Brazil	3 (0.8)
Ethiopia	1 (0.3)

3.1 |. Reporting of race and ethnicity

Overall, 44.3% of papers (n = 167) reported information on race and ethnicity across the 20-year period. White participants had the largest representation across studies (see Table 2). Some races, like those from the Middle East/Israel, were usually only identified when the study focused entirely on that population, and otherwise were unlikely to be identified in studies with participants from other racial or ethnic backgrounds. About 12% of studies included an “other” category and either did not specify what comprised “other” or listed multiple races. Ten papers (2.7%) included data on the country of birth of participants that did not fall into racial or ethnic categories. Finally, 13% of papers (n = 48) reported that most participants were White and did not include data about other participants. Overall, almost 30% of participants across all studies had data on race and ethnicity.

TABLE 2.

Racial and ethnic representation by number of studies and proportion of sample

Race/ethnicity	Number of studies	% of participantsa
		Of all studies reporting any race or ethnicity	Of studies reporting that particular race or ethnicity
White/European/Caucasian	145	69.0	72.4
Black	89	4.1	9.6
Asian (east)	80	4.4	13.3
Unspecified other	45	2.4	6.7
American Indian/Alaska native	26	0.08	2.2
Multiracial/biracial	21	0.13	9.5
Asian (south)	78	0.02	8.1
Hispanic	8	10.0	11.0
Native Hawaiian/Pacific islander	5	0.09	36.6
Middle eastern	4	0.8	99.3
Indigenous	3	0.30	56.9

^aGiven the discrepancies in reporting of race and ethnicity across the literature, and as some studies allowed participants to select more than one race or choose not to disclose race, percentages do not add up to 100.

Papers with participants from the United States were more likely to include information on race and ethnicity (74%) than those with participants outside of the United States (26%), χ²(1, N = 377) = 114.22, p = .001, NNT = 2.1. Among papers reporting race and ethnicity, White participants represented the largest race or ethnicity included, making up an average of 72.4% of all samples where they were included. This was followed by East Asian participants (13.3%) and Hispanic/Latinx participants (11%) in samples where they were included. Papers with participants from outside of Europe were more likely to include information on race and ethnicity (91.8%) than those with participants from Europe (8.2%), χ²(1, N = 377) = 38.44, p = .001, NNT = 1.2. Given that only five studies conducted in Europe reported information on race and ethnicity, racial, and ethnic breakdowns were not calculated.

3.2 |. Changes in reporting of race and ethnicity over time

Regarding change over time, a χ² analysis revealed a significant difference in the proportion of papers that reported race and ethnicity over the 20-year time period, χ²(2, N = 377) = 13.06, p = .001, such that in 2000, 31.6% of papers reported race and ethnicity; in 2010 this number increased to 44.3%; and, by 2020, 53.4% of papers reported race and ethnicity. When looking specifically at papers published in the United States, the number of studies reporting race and ethnicity changed significantly over time, χ²(2, N = 173) = 7.48, p = .02, such that in 2000, 60.4% of papers reported race and ethnicity; in 2010, 78.0% of papers reported race and ethnicity; and, by 2020, 81.0% of papers reported race and ethnicity.

From 2000 to 2020, White participants consistently made up the majority (70–75%) of samples in studies that reported race and ethnicity. However, changes in reporting occurred over time, such that unlike in 2000, the inclusion of individuals from Indigenous cultures and use of the term biracial/multiracial occurred by 2020. Six papers reported nationalities or countries of birth to contextualize the cultural background of the included participants, and over half of those were published in 2020.

3.3 |. Changes in reporting of race and ethnicity by study type and diagnosis

Overall, 61.4% of papers included clinical samples and reported eating disorder diagnoses. See Table 3 for a breakdown by diagnosis. In 2000 and 2010, papers that included participants with AN were less likely to report race and ethnicity than those that did not include participants with AN, χ²(2, N = 177) = 4.28, p = .04, NNT = 1.6 and χ²(2, N = 97) = 5.11, p = .02, NNT = 2.7, respectively. However, in 2020, this difference was no longer statistically significant. In 2000, 2010, and 2020, there was no difference in reporting race and ethnicity between papers that included participants with BN or OSFED/USFED and papers that did not include participants with BN or OSFED/USFED. We did not examine differences in reporting of race and ethnicity over time by whether participants with BED or ARFID were included given that both diagnoses were new to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) and there was an insufficient number of papers in each of the selected years to compare differences. There was no difference in reporting of race and ethnicity between intervention studies and nonintervention studies, and this did not change over time.

TABLE 3.

Eating disorder diagnostic representation by study

Diagnosis	Studies n (%)
Anorexia nervosa	168 (44.7)
Bulimia nervosa	137 (36.3)
Binge-eating disorder	74 (19.6)
Avoidant/restrictive food intake disorder	15 (4.0)
Other specified/unspecified feeding or eating disorder	100 (26.5)
No eating disorder diagnosis	238 (63.1)

4 |. DISCUSSION

Given the renewed interest in improving DEI across the eating disorders field, this study explored the racial and ethnic diversity and representation of research published in IJED over time (in 2000, 2010, and 2020). We found that less than half of papers published during these periods reported on race and ethnicity. Research within the United States. was more likely to report race and ethnicity than research outside of the United States, and research within Europe was less likely to report race and ethnicity than research outside of Europe. Overall, the number of publications reporting race and ethnicity increased from 2000 to 2020 globally. In studies that reported race and ethnicity, White participants made up close to 70% of the sample, regardless of the country where research was conducted. Finally, regarding diagnosis, there was an increase in the proportion of studies including participants with AN that reported race and ethnicity from 2000 to 2020, and no differences in racial and ethnic reporting over the 20-year period for other diagnoses.

Despite the increase in reporting of race and ethnicity over time, there continues to be ongoing international discourse about the benefits and drawbacks of including such information within research considering the lack of conceptual and definitional clarity of categories, the diverse statistical and legal categories used for racial and ethnic origin, and the lumping of minorities into one unit which tends to be in binary opposition to the ethnic origin of the majority population (Farkas, 2017). To our knowledge, there were no changes in IJED’s reporting requirements of race and ethnicity for original research studies between 2000 and 2020. Thus, increased reporting may have been driven by efforts within U.S. federal funding agencies to require reporting of race and ethnicity (NIH, 2021a) or provide additional funding for studies examining race and ethnicity (NIH, 2021b). Internationally, increases in reporting of race and ethnicity may also reflect efforts to increase awareness of racial and ethnic diversity and challenge the notion of “colorblindness” (Freire, Diaz-Bonilla, Orellana, Lopez, & Carbonari, 2018; Giuffrida, 2010). Of note, virtually no information can be drawn about the racial and ethnic composition of individuals participating in eating disorder research in Europe given the small number of papers (n = 5) that reported race and ethnicity. However, this issue is complex and likely largely influenced by both laws and practices in some European countries that do not regularly include reporting of this information.

Since there is a lack of consensus on definitions for ethnicity among scholars, internationally, and across and within disciplines (see, for summary, Hamer et al., 2020), it is critical that, when race and ethnicity are reported, accurate and respectful language is used that adequately captures the experience of the individuals involved in research. As we consider how to proceed in being inclusive, researchers need to consider ethnocultural, historical, and national contexts when adding questions and response options about ethnicity and interpreting their research findings.

Even when race and ethnicity are reported, further difficulty may arise given that a “representative” sample differs based on the population to which it is compared (e.g., state/regional, national, or international levels). We found that most studies reporting racial and ethnic information included majority White samples. These estimates may be biased given that it is impossible to know whether studies that reported race and ethnicity were more or less diverse than studies that did not report this information. Nevertheless, the majority White samples are unsurprising since most studies were conducted in White and/or Western, industrialized, rich, and democratic (i.e., WEIRD; Henrich, Heine, & Norenzayan, 2010) countries. Indeed, underrepresentation of countries outside of the WEIRD umbrella represents another form of diversity that should be increased within the eating disorders field so that the experiences of racial and ethnic minority individuals in those countries may also be evaluated. Moreover, in countries that are more homogenous regarding race and ethnicity, such data may not be collected, which makes it difficult to identify individuals who may be socially disadvantaged due to other cultural factors. It is clear that an overrepresentation of or focus on White individuals in eating disorders research limits our ability to understand factors contributing to the etiology and maintenance of eating disorder pathology within racial and ethnic minority populations and those at the intersection of racial and ethnic identities (Burke et al., 2021; Burke, Schaefer, Hazzard, & Rodgers, 2020). However, more discourse is necessary to determine the best way to address these concerns, be it through increasing studies that focus specifically on racial and ethnic minority individuals, increasing the proportion of racial and ethnic minority individuals in etiological studies, or striving for both.

Overall, it is likely that the complexity involved with collecting data on race and ethnicity has been a barrier to increasing inclusivity. However, a lack of reporting limits our ability to contextualize and generalize findings across racial and ethnic groups and may perpetuate the assumption that eating disorders affect WEIRD populations more than other racial and ethnic groups. This has a downstream impact of discouraging research examining eating disorders within non-WEIRD populations and is a problem for broader research (e.g., field of psychology) beyond eating disorders (Buchanan, Perez, Prinstein, & Thurston, 2020). Furthermore, although race and ethnicity are treated differently internationally, underrepresented groups exist globally. As such, the following recommendations aim to stimulate discussion on how to improve our understanding of the proportion of culturally underrepresented individuals within eating disorders research:

4.1 |. Recommendations

1. Research journals within the eating disorders field should consider requiring manuscripts that involve original data collection or secondary data analysis to report race and ethnicity and, when possible, to avoid characterizing samples by the proportion of the majority race or ethnicity (e.g., 75% White) with no information about the remaining 25% of the study population. If race and ethnicity were not collected, this should be explicitly addressed in the study.

2. For papers published in countries where race and ethnicity are not collected or reported in a standardized manner, authors should consider reporting other data based on a country’s ethnocultural and historical context and official groupings used by national censuses (e.g., country of origin, nationality, region of the country, religion, language).

3. Journals should require authors to provide information about race, ethnicity, or other data based on a country’s ethnocultural and historical context and official groupings used by national censuses during the manuscript submission process. Then, journals should provide an annual report with data about the reporting of race, ethnicity, and other data on underrepresented populations in published papers.

4. Papers investigating eating disorders should have samples that include racial and ethnic minority participants. If they do not, and there is no explicit rationale for the study composition, this should be stated as a significant limitation of the generalizability of the study and an explanation provided as to the lack of inclusivity in the sample.

5. Studies evaluating treatment providers should report race and ethnicity, as this identity influences clinical practice, and cannot be separated from response and beliefs (Clauss-Ehlers, Chiriboga, Hunter, Roysircar, & Tummala-Narra, 2019).

6. Journals should consider having an annual special issue focused on DEI that considers the importance of race, ethnicity, culture, and other facets of diversity (e.g., gender identity, sexual orientation, religion).

7. A working group should be convened to discuss how race and ethnicity are currently reported in eating disorder research, and to develop further recommendations for other relevant categories that may be collected in addition to or in place of race and ethnicity. For example, the Eating Disorder Research Society is an international organization that may be well positioned within the field to convene such a group, and this working group should strive to include racial and ethnic minority individuals to foster a diversity of voices. Community-based participatory research is another avenue for increasing racial and ethnic representation in research, which some eating disorders researchers currently do.

We recognize that our paper is not without limitations. First, we reviewed a sample of papers published in the past 20 years in 10-year increments (i.e., 2000, 2010, and 2020). As such, it is possible that we missed papers that held valuable information. Despite this limitation, we used a method consistent with past research (Reardon et al., 2019), and examined a relatively large sample of papers (N = 377). Second, we categorized race and ethnicity from a United States centric perspective given the well-established racial and ethnic categories and lack of international comparison. However, this makes it difficult to assess the representativeness of racial and ethnic breakdown for other countries despite there eing no systematic reporting of race and ethnicity in European countries, the second largest region represented in this review. Nevertheless, more research examining eating disorders in racial and ethnic minority populations outside of the United States is a much-needed future direction. Third, although IJED publishes studies from multiple countries, most of its articles are from the United States. Future research should investigate reporting of race and ethnicity in other eating disorder journals. Given the overall lack of representation of racial and ethnic minorities in psychology research in general (e.g., Roberts et al., 2020), we believe our recommendations are applicable to other eating disorders journals. Finally, discrepancies in reporting of race and ethnicity across studies made it difficult to statistically assess changes in racial and ethnic composition over time; consequently, we focused primarily on descriptive analyses.

Despite these limitations, this study has several strengths, including the systematic manner with which papers were evaluated, the inclusion of a sample of papers published in the last 20 years, and discussion of both racial and ethnic identities as well as the presence or absence of reporting race and ethnicity in general. This paper is a first critical step toward an understanding of the inclusion of racial and ethnic minority individuals in eating disorders research, including the transparency in reporting such data and its impact on generalizability of findings.

Overall, our paper highlights the importance of increased efforts toward better reporting of racial and ethnic diversity within eating disorders research. Failing to report race and ethnicity or to include diverse samples may limit our ability to understand eating disorders across the entire spectrum of individuals, both differences and similarities. Only through well-developed, fully powered studies that include individuals from diverse backgrounds, will we be able to delineate general risk and protective factors and specific risk and protective factors associated with racial and ethnic identities. Absent research with more diverse populations and with greater standards for representation, our research will be missing a large proportion of those whom we aim to help.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.