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Understanding and Analyzing MEPS Household Component Medical Condition Data
 





Understanding and Analyzing MEPS Household Component Medical Condition Data

by Steven Machlin, Anita Soni, and Zhengyi Fang

Introduction

MEPS Household Component (MEPS-HC) respondents are asked open-ended questions about their own medical conditions as well as those of other family members’ in various sections of the computer assisted personal interview (CAPI) questionnaire. A particular condition for an individual may be reported in all, some, or none of these sections. This document describes the reporting of medical conditions in MEPS and uses 2008 data to quantify the extent to which sample persons’ conditions are reported in different sections of the survey. A particular focus is on the extent to which the series of questions related to medical events account for condition reporting in the MEPS-HC.

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Condition Data Collection

Household respondents are asked open-ended questions about MEPS sample persons’ medical conditions in the following sections of the questionnaire: 1) Condition Enumeration (CE), 2) Medical Events (ME) and 3) Disability Days (DD). The CE section is the first among these sections and asks respondents to identify any specific physical or mental health problems for the person during the interview reference period (regardless of whether there was associated medical care or disability days). In most ME sections (medical provider office visits (MV), emergency rooms (ER), outpatient departments (OP), hospital inpatient stays (HS), prescribed medicine purchases (PM) and home health providers (HH)), household respondents are asked to identify the conditions that are associated with care/events they reported (conditions are not asked in the dental (DN) or other medical (OM) event sections)). Finally, conditions that caused sample persons to miss school or work, or spend more than half a day in bed, are ascertained in the DD section.  

A particular condition for a sample person may be reported in all, some, or none of the sections described above. Interview responses that identify conditions are recorded as verbatim text by interviewers and then professionally coded for MEPS analytic files to fully-specified ICD-9-CM codes. Specific questions for each section with condition probes are provided in the Appendix. 

In addition to open-ended reporting of conditions in the CE, ME, and DD sections, the priority condition enumeration section (PE) contains a series of “yes/no” questions on whether the person has ever been diagnosed as having each of several specific conditions that are generally chronic in nature. These conditions, which include high blood pressure, heart disease, stroke, emphysema, chronic bronchitis, high cholesterol, cancer, diabetes, joint pain, arthritis, asthma, and attention deficit disorder/attention deficit hyperactivity disorder, were deemed by the Agency for Healthcare Research and Quality (AHRQ) as “priority” for the survey due to their relatively high prevalence and generally accepted criteria for assessing appropriate clinical care. While variables based on responses to the PE questions are included in the MEPS Full Year Consolidated files, this report focuses only on the reporting of conditions in the CE, ME, and DD sections (i.e., not PE) because these sections have the potential to capture any condition and comprise the data in the MEPS Medical Conditions public use files. However, because the PE questions are asked prior to the CE, ME, and DD sections, reporting of the specific PE conditions may be greater in these subsequent sections than would have occurred in the absence of a PE section.

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MEPS Medical Conditions Files

Each record in a MEPS annual medical condition file represents a “current” condition reported as existing for a MEPS sample person at any time during the specific data year (i.e., those identified in the CE, ME, or DD sections of the questionnaire). To preserve confidentiality, diagnosis condition codes provided on the Medical Conditions file are collapsed from fully-specified 5-digit ICD-9-CM codes to 3-digit ICD-9-CM code categories.

The following table provides SAS code that can be used to identify conditions in a Medical Condition file according to which section of the questionnaire they were reported. This code reflects the methodology used to develop table 1 for this report (see “Methods” section below).

CAPI section SAS code
Medical Events (ME)

If HHNUM>0 or IPNUM>0 or OPNUM>0 or OBNUM>0 or ERNUM>0 or RXNUM>0 then Section=ME;

Disability Days (DD) but not ME

Else if MISSWORK=1 or MISSSCHL=1 or INBEDFLG=1 then Section=DD;

Condition Enumeration (CE) only

Else Section=CE_only;

While it is reasonable to presume that many conditions reported in the ME and/or DD sections were also reported in the CE section, only those conditions reported exclusively in the CE can be identified based on information provided in the Medical Conditions file (see SAS code in table above).

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Methods

Among persons with one or more records in the 2008 Medical Conditions file, table 1 shows the distributions by MEPS questionnaire section that the condition was reported for the 50 most common condition categories while table 2 provides two different types of population prevalence estimates for the 50 conditions. Persons are classified in table 1 into 3 mutually exclusive categories: 1) those with one or more medical events reported as associated with the condition, 2) those with the condition reported in DD section but no associated medical events reported, or 3) those with the condition reported in the CE section only. Table 2 shows “total” population prevalence estimates based on all persons and “treated” population estimates based on only persons with associated medical event(s) reported. The condition categories were defined using the Clinical Classification Software (CCS) which is a tool developed by AHRQ for clustering diagnoses into a manageable number of clinically meaningful policy-relevant categories (see http://meps.ahrq.gov/mepsweb/data_stats/download_data/pufs/h120/h120doc.pdf for crosswalk between CCS condition categories and component ICD-9-CM codes). The number of sample persons range across the 50 condition categories from 177 to 6,469. All estimates were weighted by the MEPS person-level weight (PERWT08F) to produce national estimates and standard errors shown in table 2 were computed using a Taylor Series estimation approach.

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Results


Table 1 shows that, in general, a high proportion of persons with a condition reported in any section had the condition identified in the medical events sections. For 32 of the 50 conditions shown, 80 percent or more of persons had medical events associated with the condition.  Moreover, 95 percent or more of persons with thyroid disease (CCS=48), diabetes (CCS=49–50), epilepsy/convulsions (CCS=83) or male genital disorders (CCS=164–166) in the Medical Conditions file had medical events associated with the condition.  In contrast, only 30 percent of persons with influenza (CCS=123) and 23 percent of those with an intestinal infection (CCS=135) reported in any section had a medical event reported for those conditions. These two conditions were more likely to be reported in the DD section (55 percent of those with influenza and 69 percent of those with intestinal infections reported).  Other conditions with a notable proportion of persons identified in the DD section (but not ME) include acute bronchitis/upper respiratory infection (URI) (36 percent, CCS=125–126), and headache (33 percent, CCS=84).  Most conditions (42 of the 50) had less than 10 percent reported in DD with no medical events reported for the same condition. Finally, for all but three of the conditions, less than 20 percent of persons were identified as having the condition in the CE section only. The three conditions with more than 20 percent identified in the CE section only were trauma-related disorders (21 percent, CCS=225–236 etc.), disorders of teeth or jaws (25 percent, CCS=136), and osteoarthritis (33 percent, CCS=201–204).

Table 1. Percentage Distribution by  Section in which Condition was Reported for Selected Condition Categories, 2008

CCS code(s) Condition category Number of persons unweighted)

Percentage distribution of condition report by section, ME1

Percentage distribution of condition report by section, DD but not ME2 Percentage distribution of condition report by section, CE only
1–9 Infectious diseases 1,993 75.2 12.5 12.4
10, 254–258 Other care and screening 1,866 84.6 2.7 12.7

1145

Cancer

1,321

89.0

1.2

9.9

46, 47

Non-malignant neoplasm

381

83.6

1.7

14.7

48

Thyroid disease

1,285

97.3

0.3

2.4

49, 50

Diabetes mellitus

2,263

95.4

0.8

3.8

51, 52, 54–58

Other endocrine, nutritional, & immune disorder

1,180

87.8

2.6

9.6

53

Hyperlipidemia

4,488

87.2

0.1

12.6

59

Anemia and other deficiencies

401

84.8

1.1

14.1

79–81

Hereditary, degenerative, and other nervous system disorders

248

90.5

0.5

9.0

83

Epilepsy and convulsions

242

95.2

0.8

4.1

84

Headache

1,394

51.6

33.2

15.2

86

Cataract

423

86.0

0.1

13.9

87, 89–91

Other eye disorders

1,823

78.7

2.9

18.4

88

Glaucoma

352

92.1

0.0

7.9

92

Otitis media

1,164

81.6

6.8

11.6

93–95

Other central nervous system (CNS) disorders

1,727

76.8

4.6

18.7

96, 97, 100–108

Heart conditions

2,343

86.7

2.1

11.2

98, 99

Hypertension

5,607

93.0

0.6

6.4

109–113

Cerebrovascular disease

402

79.9

6.1

14.0

114–121

Other circulatory conditions arteries, veins, and lymphatics

578

81.5

3.6

14.9

122

Pneumonia

432

78.9

12.7

8.5

123

Influenza

1,097

30.0

55.4

14.6

125, 126

Acute bronchitis and URI

6,469

44.7

36.0

19.3

127–134

COPD, asthma

6,105

74.2

8.6

17.3

135

Intestinal infection

3,957

23.3

68.8

7.9

136

Disorders of teeth and jaws

1,132

63.9

11.0

25.1

138–141

Disorders of the upper gastrointestinal (GI)

2,602

81.0

12.0

6.9

143

Hernias

240

80.7

5.7

13.6

144–148

Other stomach and intestinal disorders

194

86.8

4.8

8.5

149–152

Gallbladder, pancreatic, and liver disease

339

81.3

5.6

13.1

153–155

Other GI

1,041

77.3

8.8

13.9

156–158, 160, 161

Kidney disease

431

89.9

3.7

6.4

159

Urinary tract infections

849

83.2

3.7

13.1

162, 163

Other urinary

495

89.2

1.6

9.2

164–166

Male genital disorders

410

95.0

0.5

4.6

167

Non-malignant breast disease

195

84.4

0.7

14.9

168–176

Female genital disorders, and contraception

1,398

86.3

6.7

7.0

177–195

Complications of pregnancy and birth

192

78.1

9.3

12.6

196, 218

Normal birth/live born

865

80.0

6.2

13.8

197–200

Skin disorders

2,310

85.2

1.7

13.1

201–204

Osteoarthritis and other non-traumatic joint disorders

5,014

62.7

4.6

32.8

205

Back problems

2,076

75.8

7.2

17.0

206–209, 212

Other bone and musculoskeletal disease

789

89.3

1.4

9.4

210–211

Systemic lupus and connective tissues disorders

1,657

77.5

4.1

18.4

213–217

Congenital anomalies

177

82.1

0.9

17.0

225–236, 239,
240, 244

Trauma-related disorders

4,058

72.7

6.7

20.5

241–243

Poisoning by medical and non-medical substances

242

74.7

9.4

15.9

253

Allergic reactions

785

80.5

3.2

16.3

650–670

Mental disorders

4,289

79.0

6.1

15.0

1Condition may also have been reported in DD or CE sections.

2Condition may also have been reported in CE section.

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Table 2 compares “total population prevalence” estimates for the 50 condition categories based on the entire Medical Conditions file to “treated population prevalence” estimates based only on condition records associated with medical events.  It is apparent from the table that the rank orders of the two sets of population estimates are highly correlated (r=.98).  However, acute bronchitis/URI (CCS=125–126), intestinal infections (CCS=135), and influenza (CCS=123) rank notably higher in terms of total reported conditions than in terms of treated prevalence. The ratio of “treated prevalence” to “total reported” population estimates[1] ranges from 23 percent for intestinal infections (9,725,098/41,676,660) to 97 percent for thyroid disease (CCS=48) (15,434,555/15,869,425). In other words, the 2008 MEPS treated prevalence population estimate for intestinal infections is substantially lower than the total estimate (9.7 versus 41.7 million) while treated prevalence and total prevalence estimates are similar for thyroid disease (15.4 versus 15.9 million).

Table 2. Population Prevalence Estimates Based on Full Condition File Data versus only Persons w/ Medical Events, Selected Condition Categories, 2008

CCS code(s)

Condition category

Total  (full conditions file), population

Total  (full conditions file), SE

Total  (full conditions file), rank

Associated w/ medical event(s), population

Associated w/ medical event(s), SE

Associated w/ medical event(s), rank

1–9

Infectious diseases

21,989,219

788,465

14

16,526,955

625,421

14

10, 254–258

Other care and screening

20,347,107

931,518

16

17,219,615

808,617

13

1145

Cancer

17,400,124

736,081

19

15,479,928

709,324

17

46, 47

Non-malignant neoplasm

4,708,789

327,107

37

3,936,964

304,736

36

48

Thyroid disease

15,869,425

705,056

20

15,434,555

687,100

18

49, 50

Diabetes mellitus

22,170,464

723,833

13

21,157,779

717,549

11

51, 52, 54–58

Other endocrine, nutritional, and immune disorder

13,226,874

531,229

23

11,608,845

512,025

21

53

Hyperlipidemia

50,898,959

1,459,715

5

44,401,137

1,365,597

3

59

Anemia and other deficiencies

3,619,403

234,119

41

3,069,478

219,283

41

79–81

Hereditary, degenerative and other nervous system disorders

3,072,974

220,610

43

2,780,439

212,717

43

83

Epilepsy and convulsions

2,603,482

212,087

46

2,477,566

207,632

44

84

Headache

14,129,062

568,284

22

7,297,193

367,256

28

86

Cataract

5,247,714

362,558

34

4,514,756

328,839

34

87, 89–91

Other eye disorders

20,479,939

827,815

15

16,115,728

675,354

15

88

Glaucoma

3,970,976

302,947

40

3,656,679

293,172

38

92

Otitis media

11,783,337

520,238

24

9,619,883

449,185

23

93–95

Other CNS disorders

20,196,297

707,327

17

15,503,906

634,403

16

96, 97, 100–108

Heart conditions

26,788,637

936,846

10

23,234,187

879,698

8

98, 99

Hypertension

59,334,619

1,556,908

3

55,197,052

1,490,396

1

109–113

Cerebrovascular disease

4,610,873

320,606

38

3,684,310

290,958

37

114–121

Other circulatory conditions arteries, veins, and lymphatics

6,768,348

338,658

32

5,517,244

289,264

31

122

Pneumonia

4,527,763

305,919

39

3,571,130

285,979

39

123

Influenza

10,657,800

683,241

27

3,201,693

262,339

40

125, 126

Acute bronchitis and URI

68,738,432

1,895,626

1

30,735,580

928,828

7

127–134

COPD, asthma

62,697,942

1,856,151

2

46,492,922

1,469,667

2

135

Intestinal infection

41,676,660

1,423,233

8

9,725,098

514,380

22

136

Disorders of teeth and jaws

11,477,850

540,660

25

7,331,240

383,290

27

138–141

Disorders of the upper GI

27,790,982

857,891

9

22,521,248

714,505

9

143

Hernias

2,787,080

211,583

45

2,248,293

186,716

46

144–148

Other stomach and intestinal disorders

2,597,150

252,798

47

2,253,680

231,991

45

149–152

Gallbladder, pancreatic, and liver disease

3,571,157

243,743

42

2,904,198

207,600

42

153–155

Other GI

11,147,354

535,300

26

8,612,365

468,067

25

156–158, 160, 161

Kidney disease

4,719,110

321,565

36

4,242,635

318,244

35

159

Urinary tract infections

9,454,716

435,691

29

7,869,037

386,379

26

162, 163

Other urinary

5,473,173

327,429

33

4,883,913

317,867

32

164–166

Male genital disorders

5,097,348

338,889

35

4,840,044

325,804

33

167

Non-malignant breast disease

2,164,857

197,391

48

1,827,690

174,594

48

168–176

Female genital disorders, and contraception

15,812,862

637,006

21

13,644,918

617,463

20

177–195

Complications of pregnancy and birth

1,751,045

186,002

50

1,367,201

152,547

50

196, 218

Normal birth/live born

7,557,688

439,270

31

6,045,920

356,662

30

197-200

Skin disorders

25,801,812

825,649

11

21,976,284

773,751

10

201–204

Osteoarthritis and other non-traumatic joint disorders

55,944,585

1,719,769

4

35,053,634

1,133,487

5

205

Back problems

23,606,471

802,807

12

17,895,697

671,758

12

206–209, 212

Other bone and musculoskeletal disease

9,667,717

438,216

28

8,630,869

432,237

24

210–211

Systemic lupus and connective tissues disorders

18,869,533

695,706

18

14,625,583

592,138

19

213–217

Congenital anomalies

2,017,420

174,932

49

1,656,071

155,477

49

225–236, 239, 240, 244

Trauma-related disorders

45,575,137

1,297,478

7

33,140,004

1,075,738

6

241–243

Poisoning by medical and non-medical substances

2,914,645

222,170

44

2,177,129

186,994

47

253

Allergic reactions

8,230,755

427,283

30

6,624,015

365,856

29

650–670

Mental disorders

47,879,960

1,426,609

6

37,799,317

1,225,226

4

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Analytic Considerations

Quality of household reported information

MEPS condition information is reported by a household respondent and consequently subject to limitations in detail and accuracy. In general, conditions that are salient, painful, require hospitalization, require ongoing treatment, have specific recognizable treatment, alter lifestyle and/or affect daily life tend to be more accurately reported by household respondents (Machlin et. al, 2009). Moreover, research has suggested that the agreement between conditions reported by household respondents and medical providers is weak for very specific conditions, but improves as condition categories are expanded to include broader ranges of conditions (Cox and Cohen, 1985). Consequently, the Clinical Classification Codes (varname=CCCODEX) generated by CCS, which aggregate somewhat similar ICD-9-CM conditions into broad but clinically meaningful categories, are provided for analysts on the Conditions file.

Prevalence estimation limitations

As described earlier, medical conditions for MEPS sample persons are identified if reported as a general problem, associated with medical care events, or as the reason for missing school or work, or for spending days in bed during the year. When analyzing MEPS condition data, it is important to consider that persons may have conditions that are not captured in any of these sections so MEPS condition data cannot be regarded as completely exhaustive. Moreover, the household respondent reporting for other household members may not be fully aware of problematic conditions for those persons (particularly those not associated with medical events) and also may not be aware of some of their own conditions. Consequently, estimates of condition prevalence in the population during the year based on MEPS should be undertaken with caution and the quality of such estimates likely varies substantially by type of condition.

To avoid some of the problems associated with estimating condition prevalence, an option for MEPS analysts is to focus on “treated prevalence” in which conditions are ascribed to persons only if they are reported as associated with medical events in the survey. This approach has the advantages of tying the analysis directly to MEPS utilization and expenditure data, which are key components of the survey, and reducing the risk that the estimates or analysis will be misconstrued as reflecting “true” prevalence. Nonetheless, “treated prevalence” estimates are also subject to underestimation to the extent that medical events and associated conditions are underreported by respondents. It should also be considered that treated prevalence estimates from MEPS are likely to better reflect true prevalence for conditions that are salient and require ongoing treatment. For example, MEPS is commonly used to produce estimates of treated prevalence and expenditures for chronic conditions. The AHRQ Healthcare Utilization Project Chronic Condition Indicator (CCI) (http://www.hcup-us.ahrq.gov/toolssoftware/chronic/chronic.jsp) tool provides a method for identifying chronic conditions in MEPS.

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Summary

This document uses 2008 MEPS data to describe the types, sources, and limitations of condition information available from the survey. MEPS condition information is household reported and consequently subject to limitations in detail and accuracy. Household respondents are asked open-ended questions about MEPS sample persons’ medical conditions in the following sections of the questionnaire: 1) Condition Enumeration (CE), 2) Medical Events (MV, ER, OP, HS, PM, and HH) and 3) Disability Days (DD) sections. A particular condition for an individual may be reported in all, some, or none of these sections. 

Estimates of condition prevalence in the population based on MEPS should be undertaken with caution and the quality of such estimates likely varies substantially by type of condition. Most conditions are identified in MEPS as a result of their association with medical events reported by the household respondent. To avoid some of the problems in estimating total population condition prevalence, MEPS analysts may choose to focus on “treated prevalence” by ascribing conditions to persons only when reported as associated with medical events in the survey. This approach ties the analysis directly to MEPS utilization and expenditure data which are key components of the survey. 

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References

Cox B., Cohen S. A Comparison of Household and Medical Provider Reports of Medical Conditions. In: Cox B., Cohen S., eds. Methodological Issues for Health Care Surveys. New York, NY: Marcel Dekker Inc.; 1985: 150–189.

Machlin S., Cohen J., Elixhauser A., et. al. Sensitivity of Household Reported Medical Conditions in the Medical Expenditure Panel Survey. Medical Care 2009; 47: 618–625.

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Appendix. MEPS CAPI Questions Ascertaining Medical Conditions

I.                    Condition Enumeration Section

CE04

====

Between (START DATE) and (END DATE), did (PERSON) have any physical or mental health problems, accidents, or injuries?} [Please include all of (PERSON)’s conditions, accidents, or injuries regardless of whether (PERSON) saw a medical provider, received treatment, or took medications {since (START DATE)/between (START DATE) and (END DATE)}. {Also include health problems that may have been mentioned during a previous interview, but have also bothered (PERSON) {since (START DATE)/between (START DATE) and (END DATE)}.}]

CE05

====

What did (PERSON) have?

PROBE: Did (PERSON) have any other health problems, accidents, or injuries?

II.                  Medical Events Sections

Medical Provider Visits

MV08

=====

Was this visit related to any specific health condition or were any conditions discovered during this visit?

MV09

=====

What conditions were discovered or led (PERSON) to make this {visit/telephone call}?

PROBE: Any other condition?

Emergency Room

ER03

====

Was this visit related to any specific health condition or were any conditions discovered during this visit?

ER04

====

What conditions were discovered or led (PERSON) to make this visit?

PROBE: Any other condition?

Home Health

HH05

=====

What health condition led (PERSON) to receive home health care services from {someone from} (PROVIDER) during (VISIT MONTH)?

PROBE: Any other health condition?

Hospital Stay

HS03

====

Was this hospital stay related to any specific health condition or were any conditions discovered during this hospital stay?

HS04

====

What conditions were discovered or led (PERSON) to enter the hospital?

PROBE: Any other condition?

Outpatient Department

OP08

====

Was this {visit/telephone call} related to any specific health condition or were any conditions discovered during this {visit/telephone call}?

OP09

====

What conditions were discovered or led (PERSON) to make this {visit/telephone call}?

PROBE: Any other condition?

Prescribed Medicines

PMO8

=====

Is (MEDICINE) used for a specific health problem?

PMO9

=====

What health problem is (MEDICINE) prescribed for?

PROBE: Any other health problems?

III. Disability Days Section

The next questions ask about time when (PERSON) may have missed a half day or more from work or school or spent a half day or more in bed {since (START DATE)/between (START DATE) and (END DATE)}. In answering these questions, please include any time when this occurred because of (PERSON)’s physical illness or injury, or a mental or emotional problem such as stress or depression.

DD02

=====

Let's start with work. {Including the time (PERSON) (were/was) in {the hospital} {and} {the long-term care facility}, how/How} many days did (PERSON) miss a half day or more from work {since (START DATE)/between (START DATE) and (END DATE)}? Please do not include work around the house.

PROBE: Include any time when a half day or more was missed because of a physical illness or injury, or a mental or emotional problem.

DD03

=====

What are the health problems that caused (PERSON) to miss work on those days?

PROBE: Any other health problems?

DD04

=====

Of those days, how many did (PERSON) stay in bed for a half day or more?

DD05

=====

Let's talk about school (and day care). {Including the time (PERSON) (were/was) in {the hospital} {and} {the long-term care facility}, how/How} many days did (PERSON) miss a half day or more of school (or day care) {since (START DATE)/between (START DATE) and (END DATE)}?

PROBE: Include any time when a half day or more of school (or day care) was missed because of a physical illness or injury, or a mental or emotional problem.

DD06

=====

What are the health problems that caused (PERSON) to miss school on those days?

PROBE: Any other health problems?

DD07

=====

Of those days, how many did (PERSON) stay in bed a half day or more?

DD08

=====

{Besides the days in bed you just told me about, how/How} many {additional} days did (PERSON) spend a half day or more in bed {since (START DATE)/between (START DATE) and (END DATE)} because of a physical illness or injury, or mental or emotional problem?

DD09

=====

What are the health problems that caused (PERSON) to spend a half day or more in bed on those days?

PROBE: Any other health problems?



[1] This ratio is equivalent to the percent of persons with the condition identified in the events section shown in table 1.