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National Healthcare Disparities Report, 2003

Receipt of Care

Health Care Utilization

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Overall Health Care Utilization
Percent of persons with an office-based or outpatient department visit.
Percent of persons with prescription medication.
Percent of persons with dental visit.
Percent of persons with emergency room visit.
Percent of persons with inpatient discharge.
Percent of persons with home health visit.
Care in Doctor's Offices and Hospital Outpatient Departments
Outpatient visits per 100 population.
Outpatient visits where patient was seen before in clinic or practice.
Outpatient visits where patient was seen by patient's primary care provider.
Outpatient visits where patient was seen for non-illness care.
Outpatient visits with counseling or education about diet and nutrition.
Outpatient visits with counseling or education about exercise.
Outpatient visits with counseling or education about tobacco use and exposure.
Outpatient visits where physician spent more than 30 minutes with patient.
Referred Care
Outpatient visits where patient was referred by another physician or health plan.
Outpatient visits where patient was referred to another physician.
Emergency Care
Emergency department visits per 100 population.
Emergency department visits related to injury per 10,000 population.
Emergency department visits for asthma per 10,000 population.
Emergency department visits where patient was seen by intern/resident only.
Mental Health Care and Substance Abuse Treatment
Persons age 18 or older who received mental health treatment or counseling in the past year.
Persons age 18 or older who received outpatient mental health treatment or counseling in the past year.
Persons age 18 or older who received prescription medications for mental health treatment or counseling in the past year.
Persons age 18 or older who received inpatient mental health treatment or counseling in the past year.
Persons age 18 or older with serious mental illness who received mental health treatment or counseling in the past year.
Persons age 12 or older who received any illicit drug or alcohol abuse treatment in the past year.
Persons age 12 or older who needed treatment for any illicit drug use and who received such treatment at a specialty facility in the past year.
Inpatient admissions to specialty mental health organizations per 100,000 population.
Residential care admissions to specialty mental health organizations per 100,000 population.
Less than 24-hour care admissions to specialty mental health organizations per 100,000 population.
HIV Care
Hospitalizations for HIV per 10,000 population
HIV patients with 4 or more ambulatory visits in the past year.
HIV patients with CD4 < 50 with 4 or more ambulatory visits in the past year.
HIV patients with inpatient hospitalization in the past year.
HIV patients with CD4 < 50 with inpatient hospitalization in the past year.
Inpatient Care
Hospitalizations per 100 population.
Admissions for hypertension per 100,000 population.
Admissions for angina (without procedures) per 100,000 population.
Admissions for chronic obstructive pulmonary disease per 100,000 population.
Admissions for bacterial pneumonia per 100,000 population.
Admissions for perforated appendix per 1,000 admissions with appendicitis.
Number of percutaneous transluminal coronary angioplasties (PTCA) procedures per 100,000 population.
Number of coronary artery bypass grafts (CABG) per 100,000 population.
Number of hysterectomies per 100,000 population.
Number of laminectomies or spinal fusions per 100,000 population.
Number of Cesarean deliveries.
Vaginal births per 1,000 women with previous Cesarean deliveries.
Chronic Care
Adult home health care discharges per 10,000 population.
Adult nursing home discharges per 10,000 population.
Adult nursing home discharges that received at least one rehabilitative service.
Adult nursing home discharges that received mental health services.
Adult nursing home discharges that were discharged either recovered or stabilized.
Adult hospice discharges per 10,000 population.


Overall Health Care Utilization

Measure Title

Percent of persons with an office-based or outpatient department visit.

Measure Source

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

Tables

Percent of persons with an office-based or outpatient department visit, United States, 1999, by

  • Race
  • Ethnicity
  • Family income
  • Education

Data Source

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

Denominator

U.S. population (civilian, non-institutionalized).

Numerator

U.S. population (civilian, non-institutionalized) who reported at least one office-based/outpatient department visit.

Comments

Office-based/outpatient department visits include:

  • Office-based visits (physician and non-physician)
  • Outpatient department visits (physician and non-physician)
  • Inpatient visits where the admission date was the same as the discharge date (i.e., "zero-night" stays).

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Overall Health Care Utilization

Measure Title

Percent of persons with prescription medication.

Measure Source

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

Tables

Percent of persons with prescription medication, United States, 1999, by

  • Race
  • Ethnicity
  • Family income
  • Education

Data Source

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

Denominator

U.S. population (civilian, non-institutionalized).

Numerator

U.S. population (civilian, non-institutionalized) who reported at least one prescribed medication.

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Overall Health Care Utilization

Measure Title

Percent of persons with dental visit.

Measure Source

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

Tables

Percent of persons with dental, United States, 1999, by

  • Race
  • Ethnicity
  • Family income
  • Education

Data Source

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

Denominator

U.S. population (civilian, non-institutionalized).

Numerator

U.S. population (civilian, non-institutionalized) who reported at least one dental visit.

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Overall Health Care Utilization

Measure Title

Percent of persons with emergency room visit.

Measure Source

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

Tables

Percent of persons with emergency room visit, United States, 1999, by

  • Race
  • Ethnicity
  • Family income
  • Education

Data Source

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

Denominator

U.S. population (civilian, non-institutionalized).

Numerator

U.S. population (civilian, non-institutionalized) who reported at least one emergency room visit.

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Overall Health Care Utilization

Measure Title

Percent of persons with inpatient discharge.

Measure Source

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

Tables

Percent of persons with inpatient discharge, United States, 1999, by

  • Race
  • Ethnicity
  • Family income
  • Education

Data Source

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

Denominator

U.S. population (civilian, non-institutionalized).

Numerator

U.S. population (civilian, non-institutionalized) who reported at least one inpatient discharge.

Comments

Inpatient discharges exclude inpatient visits where the admission date was the same as the discharge date (i.e., "zero-night" stays).

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Overall Health Care Utilization

Measure Title

Percent of persons with home health visit.

Measure Source

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

Tables

Percent of persons with home health visit, United States, 1999, by

  • Race
  • Ethnicity
  • Family income
  • Education

Data Source

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

Denominator

U.S. population (civilian, non-institutionalized).

Numerator

U.S. population (civilian, non-institutionalized) who reported at least one home health visit.

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Care in Doctor's Offices and Hospital Outpatient Departments

Measure Title

Outpatient visits per 100 population.

Measure Source

National Center for Health Statistics (NCHS).

Tables

Outpatient visits per 100 population, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey – Outpatient Departments.

Denominator

U.S. civilian population.

Numerator

Number of visits to office-based physicians and hospital outpatient departments.

Comments

Rates are calculated using US Census Bureau monthly postcensal estimates of the civilian noninstitutional population as of July 1, 1999 and July 1, 2000 and are available at the Census Bureau Internet site: http://www.census.gov/popest/archives/1990s/nat_monthly_noninstitutional.html.

Figures have been adjusted for net underenumeration using the 1990 National Population Adjustment Matrix.

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Care in Doctor's Offices and Hospital Outpatient Departments

Measure Title

Outpatient visits where patient was seen before in clinic or practice.

Measure Source

National Center for Health Statistics (NCHS).

Tables

Outpatient visits where patient was seen before in clinic or practice, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey – Outpatient Departments.

Denominator

Number of visits to office-based physicians and hospital outpatient departments.

Numerator

Number of visits to office-based physicians and hospital outpatient departments where patient was seen before in clinic or practice.

Comments

The NAMCS/NHAMCS question is "Has Patient been Seen in this Clinic Before?" or "Have You or Anyone in your Practice/Department Seen Patient Before?"

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Care in Doctor's Offices and Hospital Outpatient Departments

Measure Title

Outpatient visits where patient was seen by patient's primary care provider.

Measure Source

National Center for Health Statistics (NCHS).

Tables

Outpatient visits where patient was seen by patient's primary care provider, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey – Outpatient Departments.

Denominator

Number of visits to office-based physicians and hospital outpatient departments.

Numerator

Number of visits to office-based physicians and hospital outpatient departments where patient was seen by patient's primary care provider.

Comments

The NAMCS/NHAMCS question is "Are You The Patient's Primary Care Physician?"

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Care in Doctor's Offices and Hospital Outpatient Departments

Measure Title

Outpatient visits where patient was seen for non-illness care.

Measure Source

National Center for Health Statistics (NCHS).

Tables

Outpatient visits where patient was seen for non-illness care, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey – Outpatient Departments.

Denominator

Number of visits to office-based physicians and hospital outpatient departments.

Numerator

Number of visits to office-based physicians and hospital outpatient departments where patient was seen for non-illness care.

Comments

The NAMCS/NHAMCS question is "Major Reason for this visit" with response "Non-illness care (e.g., routine, prenatal, general exam., well baby)".

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Care in Doctor's Offices and Hospital Outpatient Departments

Measure Title

Outpatient visits with counseling or education about diet and nutrition.

Measure Source

National Center for Health Statistics (NCHS).

Tables

Outpatient visits with counseling or education about diet and nutrition, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey – Outpatient Departments.

Denominator

Number of visits to office-based physicians and hospital outpatient departments.

Numerator

Number of visits to office-based physicians and hospital outpatient departments with counseling or education about diet and nutrition.

Comments

The NAMCS/NHAMCS question is "Therapeutic and Preventive Services Ordered or Provided at this visit" with response "Counseling/Education: Diet/nutrition".

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Care in Doctor's Offices and Hospital Outpatient Departments

Measure Title

Outpatient visits with counseling or education about exercise.

Measure Source

National Center for Health Statistics (NCHS).

Tables

Outpatient visits with counseling or education about exercise, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey – Outpatient Departments.

Denominator

Number of visits to office-based physicians and hospital outpatient departments.

Numerator

Number of visits to office-based physicians and hospital outpatient departments with counseling or education about exercise.

Comments

The NAMCS/NHAMCS question is "Therapeutic and Preventive Services Ordered or Provided at this visit" with response "Counseling/Education: Exercise".

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Care in Doctor's Offices and Hospital Outpatient Departments

Measure Title

Outpatient visits with counseling or education about tobacco use and exposure.

Measure Source

National Center for Health Statistics (NCHS).

Tables

Outpatient visits with counseling or education about tobacco use and exposure, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey – Outpatient Departments.

Denominator

Number of visits to office-based physicians and hospital outpatient departments.

Numerator

Number of visits to office-based physicians and hospital outpatient departments with counseling or education about tobacco use and exposure.

Comments

The NAMCS/NHAMCS question is "Therapeutic and Preventive Services Ordered or Provided at this visit" with response "Counseling/Education: Tobacco Use/Exposure".

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Care in Doctor's Offices and Hospital Outpatient Departments

Measure Title

Outpatient visits where physician spent more than 30 minutes with patient.

Measure Source

National Center for Health Statistics (NCHS).

Tables

Outpatient visits where physician spent more than 30 minutes with patient, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey – Outpatient Departments.

Denominator

Number of visits to office-based physicians and hospital outpatient departments.

Numerator

Number of visits to office-based physicians and hospital outpatient departments where physician spent more than 30 minutes with patient.

Comments

The NAMCS/NHAMCS question is "Time Spent With Physician (In Minutes)" with response recoded to 30 or more minutes.

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Referred Care

Measure Title

Outpatient visits where patient was referred by another physician or health plan.

Measure Source

National Center for Health Statistics (NCHS).

Tables

Outpatient visits where patient was referred by another physician or health plan, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey – Outpatient Departments.

Denominator

Number of visits to office-based physicians and hospital outpatient departments.

Numerator

Number of visits to office-based physicians and hospital outpatient departments where patient was referred by another physician or health plan.

Comments

The NAMCS/NHAMCS question is "Was Patient Referred by Another Physician or by a Health Plan for this Visit?".

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Referred Care

Measure Title

Outpatient visits where patient was referred to another physician.

Measure Source

National Center for Health Statistics (NCHS).

Tables

Outpatient visits where patient was referred to another physician, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey – Outpatient Departments.

Denominator

Number of visits to office-based physicians and hospital outpatient departments.

Numerator

Number of visits to office-based physicians and hospital outpatient departments where patient was referred to another physician.

Comments

The NAMCS/NHAMCS question is "Visit Disposition" with response "Referred to other physician".

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Emergency Care

Measure Title

Emergency department visits per 100 population.

Measure Source

National Center for Health Statistics (NCHS).

Tables

Emergency department visits per 100 population, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey – Emergency Departments.

Denominator

U.S. civilian population.

Numerator

Number of visits to hospital emergency departments.

Comments

Rates are calculated using US Census Bureau monthly postcensal estimates of the civilian noninstitutional population as of July 1, 1999 and July 1, 2000 and are available at the Census Bureau Internet site: http://www.census.gov/popest/archives/1990s/nat_monthly_noninstitutional.html.

Figures have been adjusted for net underenumeration using the 1990 National Population Adjustment Matrix.

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Emergency Care

Measure Title

Emergency department visits related to injury per 10,000 population.

Measure Source

National Center for Health Statistics (NCHS).

Tables

Emergency department visits related to injury per 10,000 population, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey – Emergency Departments.

Denominator

U.S. civilian population.

Numerator

Number of visits to hospital emergency departments related to injury or poisoning.

Comments

Rates are calculated using US Census Bureau monthly postcensal estimates of the civilian noninstitutional population as of July 1, 1999 and July 1, 2000 and are available at the Census Bureau Internet site: http://www.census.gov/popest/archives/1990s/nat_monthly_noninstitutional.html.

Figures have been adjusted for net underenumeration using the 1990 National Population Adjustment Matrix.

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Emergency Care

Measure Title

Emergency department visits for asthma per 10,000 population.

Measure Source

Healthy People 2010, measure 24-3.

Tables

Emergency department visits related to injury per 10,000 population, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey – Emergency Departments.

Denominator

U.S. civilian population.

Numerator

Number of visits to hospital emergency departments with first listed diagnosis of asthma (ICD-9-CM code 493).

Comments

Rates are calculated using US Census Bureau monthly postcensal estimates of the civilian noninstitutional population as of July 1, 1999 and July 1, 2000 and are available at the Census Bureau Internet site: http://www.census.gov/popest/archives/1990s/nat_monthly_noninstitutional.html.

Figures have been adjusted for net underenumeration using the 1990 National Population Adjustment Matrix.

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Emergency Care

Measure Title

Emergency department visits where patient was seen by intern/resident only.

Measure Source

Healthy People 2010, measure 24-3.

Tables

Emergency department visits where patient was seen by intern/resident only, United States, 1999-2000, by

  • Race

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey – Emergency Departments.

Denominator

Number of visits to hospital emergency departments.

Numerator

Number of visits to hospital emergency departments where patient was seen by intern/resident only.

Comments

The NHAMCS ED question is "Providers Seen This Visit" with response "Resident/intern".

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Mental Health Care and Substance Abuse Treatment

Measure Title

Persons age 18 or older who received mental health treatment or counseling in the past year.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

Persons age 18 or older who received mental health treatment or counseling in the past year, United States, 2001, by

  • Race
  • Ethnicity
  • Education

Data Source

Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse.

Denominator

Persons age 18 or older.

Numerator

Persons age 18 or older who reported receipt of mental health treatment or counseling in the past year.

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Mental Health Care and Substance Abuse Treatment

Measure Title

Persons age 18 or older who received outpatient mental health treatment or counseling in the past year.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

Persons age 18 or older who received outpatient mental health treatment or counseling in the past year, United States, 2001, by

  • Race
  • Ethnicity
  • Education

Data Source

Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse.

Denominator

Persons age 18 or older.

Numerator

Persons age 18 or older who reported receipt of outpatient mental health treatment or counseling in the past year.

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Mental Health Care and Substance Abuse Treatment

Measure Title

Persons age 18 or older who received prescription medications for mental health treatment or counseling in the past year.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

Persons age 18 or older who received prescription medications for mental health treatment or counseling in the past year, United States, 2001, by

  • Race
  • Ethnicity
  • Education

Data Source

Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse.

Denominator

Persons age 18 or older.

Numerator

Persons age 18 or older who reported receipt of prescription medications for mental health treatment or counseling in the past year.

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Mental Health Care and Substance Abuse Treatment

Measure Title

Persons age 18 or older who received inpatient mental health treatment or counseling in the past year.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

Persons age 18 or older who received inpatient mental health treatment or counseling in the past year, United States, 2001, by

  • Race
  • Ethnicity
  • Education

Data Source

Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse.

Denominator

Persons age 18 or older.

Numerator

Persons age 18 or older who reported receipt of inpatient mental health treatment or counseling in the past year.

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Mental Health Care and Substance Abuse Treatment

Measure Title

Persons age 18 or older with serious mental illness who received mental health treatment or counseling in the past year.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

Persons age 18 or older with serious mental illness who received mental health treatment or counseling in the past year, United States, 2001, by

  • Race
  • Ethnicity
  • Education

Data Source

Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse.

Denominator

Persons age 18 or older with serious mental illness.

Numerator

Persons age 18 or older with serious mental illness who received mental health treatment or counseling in the past year.

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Mental Health Care and Substance Abuse Treatment

Measure Title

Persons age 12 or older who received any illicit drug or alcohol abuse treatment in the past year.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

Persons age 12 or older who received any illicit drug or alcohol abuse treatment in the past year, United States, 2001, by

  • Race
  • Ethnicity
  • Education

Data Source

Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse.

Denominator

Persons age 12 or older.

Numerator

Persons age 12 or older who received any illicit drug or alcohol abuse treatment in the past year.

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Mental Health Care and Substance Abuse Treatment

Measure Title

Persons age 12 or older who needed treatment for any illicit drug use and who received such treatment at a specialty facility in the past year.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

Persons age 12 or older who needed treatment for any illicit drug use and who received such treatment at a specialty facility in the past year, United States, 2001, by

  • Race
  • Ethnicity
  • Education

Data Source

Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse.

Denominator

Persons age 12 or older who needed treatment for any illicit drug use.

Numerator

Persons age 12 or older who needed treatment for any illicit drug use and who received such treatment at a specialty facility in the past year.

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Mental Health Care and Substance Abuse Treatment

Measure Title

Inpatient admissions to specialty mental health organizations per 100,000 population.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

Inpatient admissions to specialty mental health organizations per 100,000 population, United States, 1997, by

  • Race
  • Ethnicity

Data Source

Substance Abuse and Mental Health Services Administration, 1997 Client/Patient Sample Survey.

Denominator

U.S. civilian population.

Numerator

Inpatient admissions to specialty mental health organizations.

Comments

Rate computations are based on the U. S. Bureau of the Census population estimates for May 1997.

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Mental Health Care and Substance Abuse Treatment

Measure Title

Residential care admissions to specialty mental health organizations per 100,000 population.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

Residential care admissions to specialty mental health organizations per 100,000 population, United States, 1997, by

  • Race
  • Ethnicity

Data Source

Substance Abuse and Mental Health Services Administration, 1997 Client/Patient Sample Survey.

Denominator

U.S. civilian population.

Numerator

Residential care admissions to specialty mental health organizations.

Comments

Rate computations are based on the U. S. Bureau of the Census population estimates for May 1997.

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Mental Health Care and Substance Abuse Treatment

Measure Title

Less than 24-hour care admissions to specialty mental health organizations per 100,000 population.

Measure Source

Substance Abuse and Mental Health Services Administration (SAMHSA).

Tables

Less than 24-hour care admissions to specialty mental health organizations per 100,000 population, United States, 1997, by

  • Race
  • Ethnicity

Data Source

Substance Abuse and Mental Health Services Administration, 1997 Client/Patient Sample Survey.

Denominator

U.S. civilian population.

Numerator

Less than 24-hour care admissions to specialty mental health organizations.

Comments

Rate computations are based on the U. S. Bureau of the Census population estimates for May 1997.


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