Stock Analysis on Net

Shockwave Medical Inc. (NASDAQ:SWAV)

Analysis of Solvency Ratios

Microsoft Excel

Solvency Ratios (Summary)

Shockwave Medical Inc., solvency ratios

Microsoft Excel
Dec 31, 2023 Dec 31, 2022 Dec 31, 2021 Dec 31, 2020 Dec 31, 2019
Debt Ratios
Debt to equity 1.09 0.05 0.07 0.07 0.07
Debt to equity (including operating lease liability) 1.15 0.12 0.20 0.11 0.12
Debt to capital 0.52 0.05 0.07 0.07 0.07
Debt to capital (including operating lease liability) 0.54 0.11 0.16 0.10 0.11
Debt to assets 0.47 0.04 0.05 0.06 0.06
Debt to assets (including operating lease liability) 0.49 0.09 0.14 0.09 0.10
Financial leverage 2.34 1.26 1.43 1.21 1.20
Coverage Ratios
Interest coverage 26.24 65.07 -7.06 -53.14 -53.08
Fixed charge coverage 15.51 19.44 -1.22 -18.19 -22.81

Based on: 10-K (reporting date: 2023-12-31), 10-K (reporting date: 2022-12-31), 10-K (reporting date: 2021-12-31), 10-K (reporting date: 2020-12-31), 10-K (reporting date: 2019-12-31).

Solvency ratio Description The company
Debt to equity ratio A solvency ratio calculated as total debt divided by total shareholders’ equity. Shockwave Medical Inc. debt to equity ratio improved from 2021 to 2022 but then deteriorated significantly from 2022 to 2023.
Debt to equity ratio (including operating lease liability) A solvency ratio calculated as total debt (including operating lease liability) divided by total shareholders’ equity. Shockwave Medical Inc. debt to equity ratio (including operating lease liability) improved from 2021 to 2022 but then deteriorated significantly from 2022 to 2023.
Debt to capital ratio A solvency ratio calculated as total debt divided by total debt plus shareholders’ equity. Shockwave Medical Inc. debt to capital ratio improved from 2021 to 2022 but then deteriorated significantly from 2022 to 2023.
Debt to capital ratio (including operating lease liability) A solvency ratio calculated as total debt (including operating lease liability) divided by total debt (including operating lease liability) plus shareholders’ equity. Shockwave Medical Inc. debt to capital ratio (including operating lease liability) improved from 2021 to 2022 but then deteriorated significantly from 2022 to 2023.
Debt to assets ratio A solvency ratio calculated as total debt divided by total assets. Shockwave Medical Inc. debt to assets ratio improved from 2021 to 2022 but then deteriorated significantly from 2022 to 2023.
Debt to assets ratio (including operating lease liability) A solvency ratio calculated as total debt (including operating lease liability) divided by total assets. Shockwave Medical Inc. debt to assets ratio (including operating lease liability) improved from 2021 to 2022 but then deteriorated significantly from 2022 to 2023.
Financial leverage ratio A solvency ratio calculated as total assets divided by total shareholders’ equity. Shockwave Medical Inc. financial leverage ratio decreased from 2021 to 2022 but then increased from 2022 to 2023 exceeding 2021 level.

Solvency ratio Description The company
Interest coverage ratio A solvency ratio calculated as EBIT divided by interest payments. Shockwave Medical Inc. interest coverage ratio improved from 2021 to 2022 but then slightly deteriorated from 2022 to 2023 not reaching 2021 level.
Fixed charge coverage ratio A solvency ratio calculated as earnings before fixed charges and tax divided by fixed charges. Shockwave Medical Inc. fixed charge coverage ratio improved from 2021 to 2022 but then slightly deteriorated from 2022 to 2023.

Debt to Equity

Shockwave Medical Inc., debt to equity calculation, comparison to benchmarks

Microsoft Excel
Dec 31, 2023 Dec 31, 2022 Dec 31, 2021 Dec 31, 2020 Dec 31, 2019
Selected Financial Data (US$ in thousands)
Debt, current portion 5,500 3,300 6,667
Convertible debt, noncurrent portion 731,863
Debt, noncurrent portion 24,198 11,630 13,319 7,152
Total debt 731,863 24,198 17,130 16,619 13,819
 
Stockholders’ equity 668,677 511,316 241,830 225,654 192,653
Solvency Ratio
Debt to equity1 1.09 0.05 0.07 0.07 0.07
Benchmarks
Debt to Equity, Competitors2
Abbott Laboratories 0.38 0.46 0.50 0.57 0.58
Cigna Group 0.67 0.69 0.71 0.65 0.83
CVS Health Corp. 0.81 0.74 0.75 0.93 1.07
Elevance Health Inc. 0.64 0.66 0.64 0.60 0.63
Humana Inc. 0.74 0.75 0.80 0.51 0.49
Intuitive Surgical Inc. 0.00 0.00 0.00 0.00 0.00
Medtronic PLC 0.47 0.46 0.51 0.49 0.51
UnitedHealth Group Inc. 0.70 0.74 0.64 0.66 0.71
Debt to Equity, Sector
Health Care Equipment & Services 0.63 0.63 0.63 0.65 0.72
Debt to Equity, Industry
Health Care 0.83 0.74 0.80 0.91 0.92

Based on: 10-K (reporting date: 2023-12-31), 10-K (reporting date: 2022-12-31), 10-K (reporting date: 2021-12-31), 10-K (reporting date: 2020-12-31), 10-K (reporting date: 2019-12-31).

1 2023 Calculation
Debt to equity = Total debt ÷ Stockholders’ equity
= 731,863 ÷ 668,677 = 1.09

2 Click competitor name to see calculations.

Solvency ratio Description The company
Debt to equity ratio A solvency ratio calculated as total debt divided by total shareholders’ equity. Shockwave Medical Inc. debt to equity ratio improved from 2021 to 2022 but then deteriorated significantly from 2022 to 2023.

Debt to Equity (including Operating Lease Liability)

Shockwave Medical Inc., debt to equity (including operating lease liability) calculation, comparison to benchmarks

Microsoft Excel
Dec 31, 2023 Dec 31, 2022 Dec 31, 2021 Dec 31, 2020 Dec 31, 2019
Selected Financial Data (US$ in thousands)
Debt, current portion 5,500 3,300 6,667
Convertible debt, noncurrent portion 731,863
Debt, noncurrent portion 24,198 11,630 13,319 7,152
Total debt 731,863 24,198 17,130 16,619 13,819
Operating lease liability, current portion 3,641 1,278 1,738 873 774
Operating lease liability, noncurrent portion 35,103 34,928 28,321 7,488 8,125
Total debt (including operating lease liability) 770,607 60,404 47,189 24,980 22,718
 
Stockholders’ equity 668,677 511,316 241,830 225,654 192,653
Solvency Ratio
Debt to equity (including operating lease liability)1 1.15 0.12 0.20 0.11 0.12
Benchmarks
Debt to Equity (including Operating Lease Liability), Competitors2
Abbott Laboratories 0.41 0.49 0.54 0.61 0.61
Cigna Group 0.68 0.70 0.73 0.67 0.84
CVS Health Corp. 1.04 1.00 1.01 1.23 1.39
Elevance Health Inc. 0.66 0.69 0.67 0.63 0.65
Humana Inc. 0.77 0.79 0.84 0.54 0.53
Intuitive Surgical Inc. 0.01 0.01 0.01 0.01 0.01
Medtronic PLC 0.49 0.48 0.53 0.51 0.51
UnitedHealth Group Inc. 0.76 0.80 0.70 0.73 0.77
Debt to Equity (including Operating Lease Liability), Sector
Health Care Equipment & Services 0.70 0.71 0.71 0.74 0.81
Debt to Equity (including Operating Lease Liability), Industry
Health Care 0.88 0.80 0.86 0.97 0.98

Based on: 10-K (reporting date: 2023-12-31), 10-K (reporting date: 2022-12-31), 10-K (reporting date: 2021-12-31), 10-K (reporting date: 2020-12-31), 10-K (reporting date: 2019-12-31).

1 2023 Calculation
Debt to equity (including operating lease liability) = Total debt (including operating lease liability) ÷ Stockholders’ equity
= 770,607 ÷ 668,677 = 1.15

2 Click competitor name to see calculations.

Solvency ratio Description The company
Debt to equity ratio (including operating lease liability) A solvency ratio calculated as total debt (including operating lease liability) divided by total shareholders’ equity. Shockwave Medical Inc. debt to equity ratio (including operating lease liability) improved from 2021 to 2022 but then deteriorated significantly from 2022 to 2023.

Debt to Capital

Shockwave Medical Inc., debt to capital calculation, comparison to benchmarks

Microsoft Excel
Dec 31, 2023 Dec 31, 2022 Dec 31, 2021 Dec 31, 2020 Dec 31, 2019
Selected Financial Data (US$ in thousands)
Debt, current portion 5,500 3,300 6,667
Convertible debt, noncurrent portion 731,863
Debt, noncurrent portion 24,198 11,630 13,319 7,152
Total debt 731,863 24,198 17,130 16,619 13,819
Stockholders’ equity 668,677 511,316 241,830 225,654 192,653
Total capital 1,400,540 535,514 258,960 242,273 206,472
Solvency Ratio
Debt to capital1 0.52 0.05 0.07 0.07 0.07
Benchmarks
Debt to Capital, Competitors2
Abbott Laboratories 0.28 0.31 0.34 0.36 0.37
Cigna Group 0.40 0.41 0.42 0.40 0.45
CVS Health Corp. 0.45 0.42 0.43 0.48 0.52
Elevance Health Inc. 0.39 0.40 0.39 0.38 0.39
Humana Inc. 0.42 0.43 0.44 0.34 0.33
Intuitive Surgical Inc. 0.00 0.00 0.00 0.00 0.00
Medtronic PLC 0.32 0.31 0.34 0.33 0.34
UnitedHealth Group Inc. 0.41 0.43 0.39 0.40 0.41
Debt to Capital, Sector
Health Care Equipment & Services 0.38 0.39 0.38 0.39 0.42
Debt to Capital, Industry
Health Care 0.45 0.43 0.44 0.48 0.48

Based on: 10-K (reporting date: 2023-12-31), 10-K (reporting date: 2022-12-31), 10-K (reporting date: 2021-12-31), 10-K (reporting date: 2020-12-31), 10-K (reporting date: 2019-12-31).

1 2023 Calculation
Debt to capital = Total debt ÷ Total capital
= 731,863 ÷ 1,400,540 = 0.52

2 Click competitor name to see calculations.

Solvency ratio Description The company
Debt to capital ratio A solvency ratio calculated as total debt divided by total debt plus shareholders’ equity. Shockwave Medical Inc. debt to capital ratio improved from 2021 to 2022 but then deteriorated significantly from 2022 to 2023.

Debt to Capital (including Operating Lease Liability)

Shockwave Medical Inc., debt to capital (including operating lease liability) calculation, comparison to benchmarks

Microsoft Excel
Dec 31, 2023 Dec 31, 2022 Dec 31, 2021 Dec 31, 2020 Dec 31, 2019
Selected Financial Data (US$ in thousands)
Debt, current portion 5,500 3,300 6,667
Convertible debt, noncurrent portion 731,863
Debt, noncurrent portion 24,198 11,630 13,319 7,152
Total debt 731,863 24,198 17,130 16,619 13,819
Operating lease liability, current portion 3,641 1,278 1,738 873 774
Operating lease liability, noncurrent portion 35,103 34,928 28,321 7,488 8,125
Total debt (including operating lease liability) 770,607 60,404 47,189 24,980 22,718
Stockholders’ equity 668,677 511,316 241,830 225,654 192,653
Total capital (including operating lease liability) 1,439,284 571,720 289,019 250,634 215,371
Solvency Ratio
Debt to capital (including operating lease liability)1 0.54 0.11 0.16 0.10 0.11
Benchmarks
Debt to Capital (including Operating Lease Liability), Competitors2
Abbott Laboratories 0.29 0.33 0.35 0.38 0.38
Cigna Group 0.40 0.41 0.42 0.40 0.46
CVS Health Corp. 0.51 0.50 0.50 0.55 0.58
Elevance Health Inc. 0.40 0.41 0.40 0.39 0.40
Humana Inc. 0.44 0.44 0.46 0.35 0.34
Intuitive Surgical Inc. 0.01 0.01 0.01 0.01 0.01
Medtronic PLC 0.33 0.32 0.35 0.34 0.34
UnitedHealth Group Inc. 0.43 0.45 0.41 0.42 0.44
Debt to Capital (including Operating Lease Liability), Sector
Health Care Equipment & Services 0.41 0.41 0.41 0.43 0.45
Debt to Capital (including Operating Lease Liability), Industry
Health Care 0.47 0.44 0.46 0.49 0.49

Based on: 10-K (reporting date: 2023-12-31), 10-K (reporting date: 2022-12-31), 10-K (reporting date: 2021-12-31), 10-K (reporting date: 2020-12-31), 10-K (reporting date: 2019-12-31).

1 2023 Calculation
Debt to capital (including operating lease liability) = Total debt (including operating lease liability) ÷ Total capital (including operating lease liability)
= 770,607 ÷ 1,439,284 = 0.54

2 Click competitor name to see calculations.

Solvency ratio Description The company
Debt to capital ratio (including operating lease liability) A solvency ratio calculated as total debt (including operating lease liability) divided by total debt (including operating lease liability) plus shareholders’ equity. Shockwave Medical Inc. debt to capital ratio (including operating lease liability) improved from 2021 to 2022 but then deteriorated significantly from 2022 to 2023.

Debt to Assets

Shockwave Medical Inc., debt to assets calculation, comparison to benchmarks

Microsoft Excel
Dec 31, 2023 Dec 31, 2022 Dec 31, 2021 Dec 31, 2020 Dec 31, 2019
Selected Financial Data (US$ in thousands)
Debt, current portion 5,500 3,300 6,667
Convertible debt, noncurrent portion 731,863
Debt, noncurrent portion 24,198 11,630 13,319 7,152
Total debt 731,863 24,198 17,130 16,619 13,819
 
Total assets 1,566,563 646,089 345,682 272,042 231,938
Solvency Ratio
Debt to assets1 0.47 0.04 0.05 0.06 0.06
Benchmarks
Debt to Assets, Competitors2
Abbott Laboratories 0.20 0.23 0.24 0.26 0.27
Cigna Group 0.20 0.22 0.22 0.21 0.24
CVS Health Corp. 0.25 0.23 0.24 0.28 0.31
Elevance Health Inc. 0.23 0.23 0.24 0.23 0.26
Humana Inc. 0.26 0.27 0.29 0.20 0.20
Intuitive Surgical Inc. 0.00 0.00 0.00 0.00 0.00
Medtronic PLC 0.27 0.27 0.28 0.27 0.28
UnitedHealth Group Inc. 0.23 0.23 0.22 0.22 0.23
Debt to Assets, Sector
Health Care Equipment & Services 0.23 0.23 0.23 0.24 0.26
Debt to Assets, Industry
Health Care 0.29 0.28 0.29 0.31 0.31

Based on: 10-K (reporting date: 2023-12-31), 10-K (reporting date: 2022-12-31), 10-K (reporting date: 2021-12-31), 10-K (reporting date: 2020-12-31), 10-K (reporting date: 2019-12-31).

1 2023 Calculation
Debt to assets = Total debt ÷ Total assets
= 731,863 ÷ 1,566,563 = 0.47

2 Click competitor name to see calculations.

Solvency ratio Description The company
Debt to assets ratio A solvency ratio calculated as total debt divided by total assets. Shockwave Medical Inc. debt to assets ratio improved from 2021 to 2022 but then deteriorated significantly from 2022 to 2023.

Debt to Assets (including Operating Lease Liability)

Shockwave Medical Inc., debt to assets (including operating lease liability) calculation, comparison to benchmarks

Microsoft Excel
Dec 31, 2023 Dec 31, 2022 Dec 31, 2021 Dec 31, 2020 Dec 31, 2019
Selected Financial Data (US$ in thousands)
Debt, current portion 5,500 3,300 6,667
Convertible debt, noncurrent portion 731,863
Debt, noncurrent portion 24,198 11,630 13,319 7,152
Total debt 731,863 24,198 17,130 16,619 13,819
Operating lease liability, current portion 3,641 1,278 1,738 873 774
Operating lease liability, noncurrent portion 35,103 34,928 28,321 7,488 8,125
Total debt (including operating lease liability) 770,607 60,404 47,189 24,980 22,718
 
Total assets 1,566,563 646,089 345,682 272,042 231,938
Solvency Ratio
Debt to assets (including operating lease liability)1 0.49 0.09 0.14 0.09 0.10
Benchmarks
Debt to Assets (including Operating Lease Liability), Competitors2
Abbott Laboratories 0.22 0.24 0.26 0.27 0.28
Cigna Group 0.21 0.22 0.22 0.22 0.24
CVS Health Corp. 0.32 0.31 0.33 0.37 0.40
Elevance Health Inc. 0.24 0.24 0.25 0.24 0.27
Humana Inc. 0.27 0.28 0.31 0.21 0.22
Intuitive Surgical Inc. 0.01 0.01 0.01 0.01 0.01
Medtronic PLC 0.28 0.27 0.29 0.28 0.28
UnitedHealth Group Inc. 0.25 0.25 0.24 0.24 0.26
Debt to Assets (including Operating Lease Liability), Sector
Health Care Equipment & Services 0.26 0.26 0.27 0.27 0.29
Debt to Assets (including Operating Lease Liability), Industry
Health Care 0.31 0.29 0.31 0.33 0.33

Based on: 10-K (reporting date: 2023-12-31), 10-K (reporting date: 2022-12-31), 10-K (reporting date: 2021-12-31), 10-K (reporting date: 2020-12-31), 10-K (reporting date: 2019-12-31).

1 2023 Calculation
Debt to assets (including operating lease liability) = Total debt (including operating lease liability) ÷ Total assets
= 770,607 ÷ 1,566,563 = 0.49

2 Click competitor name to see calculations.

Solvency ratio Description The company
Debt to assets ratio (including operating lease liability) A solvency ratio calculated as total debt (including operating lease liability) divided by total assets. Shockwave Medical Inc. debt to assets ratio (including operating lease liability) improved from 2021 to 2022 but then deteriorated significantly from 2022 to 2023.

Financial Leverage

Shockwave Medical Inc., financial leverage calculation, comparison to benchmarks

Microsoft Excel
Dec 31, 2023 Dec 31, 2022 Dec 31, 2021 Dec 31, 2020 Dec 31, 2019
Selected Financial Data (US$ in thousands)
Total assets 1,566,563 646,089 345,682 272,042 231,938
Stockholders’ equity 668,677 511,316 241,830 225,654 192,653
Solvency Ratio
Financial leverage1 2.34 1.26 1.43 1.21 1.20
Benchmarks
Financial Leverage, Competitors2
Abbott Laboratories 1.90 2.03 2.10 2.21 2.18
Cigna Group 3.30 3.21 3.29 3.09 3.44
CVS Health Corp. 3.27 3.21 3.10 3.32 3.48
Elevance Health Inc. 2.77 2.83 2.70 2.61 2.44
Humana Inc. 2.89 2.81 2.76 2.55 2.42
Intuitive Surgical Inc. 1.16 1.17 1.14 1.15 1.18
Medtronic PLC 1.77 1.73 1.81 1.79 1.79
UnitedHealth Group Inc. 3.08 3.16 2.96 3.01 3.02
Financial Leverage, Sector
Health Care Equipment & Services 2.73 2.72 2.67 2.70 2.75
Financial Leverage, Industry
Health Care 2.83 2.70 2.79 2.96 2.93

Based on: 10-K (reporting date: 2023-12-31), 10-K (reporting date: 2022-12-31), 10-K (reporting date: 2021-12-31), 10-K (reporting date: 2020-12-31), 10-K (reporting date: 2019-12-31).

1 2023 Calculation
Financial leverage = Total assets ÷ Stockholders’ equity
= 1,566,563 ÷ 668,677 = 2.34

2 Click competitor name to see calculations.

Solvency ratio Description The company
Financial leverage ratio A solvency ratio calculated as total assets divided by total shareholders’ equity. Shockwave Medical Inc. financial leverage ratio decreased from 2021 to 2022 but then increased from 2022 to 2023 exceeding 2021 level.

Interest Coverage

Shockwave Medical Inc., interest coverage calculation, comparison to benchmarks

Microsoft Excel
Dec 31, 2023 Dec 31, 2022 Dec 31, 2021 Dec 31, 2020 Dec 31, 2019
Selected Financial Data (US$ in thousands)
Net income (loss) 147,278 215,996 (9,136) (65,699) (51,109)
Add: Income tax expense 27,003 (95,168) 301 80 62
Add: Interest expense 6,905 1,886 1,096 1,212 944
Earnings before interest and tax (EBIT) 181,186 122,714 (7,739) (64,407) (50,103)
Solvency Ratio
Interest coverage1 26.24 65.07 -7.06 -53.14 -53.08
Benchmarks
Interest Coverage, Competitors2
Abbott Laboratories 11.46 15.89 16.41 10.10 7.09
Cigna Group 4.94 7.43 6.22 8.76 5.11
CVS Health Corp. 5.20 3.46 5.16 4.36 3.96
Elevance Health Inc. 8.49 10.13 10.93 8.96 9.02
Humana Inc. 7.73 9.89 11.49 17.52 15.34
Intuitive Surgical Inc.
Medtronic PLC 9.43 10.98 5.21 4.71 4.60
UnitedHealth Group Inc. 9.97 13.59 14.44 13.47 11.55
Interest Coverage, Sector
Health Care Equipment & Services 8.02 9.36 9.06 8.20 6.69
Interest Coverage, Industry
Health Care 7.00 12.46 12.10 7.74 8.87

Based on: 10-K (reporting date: 2023-12-31), 10-K (reporting date: 2022-12-31), 10-K (reporting date: 2021-12-31), 10-K (reporting date: 2020-12-31), 10-K (reporting date: 2019-12-31).

1 2023 Calculation
Interest coverage = EBIT ÷ Interest expense
= 181,186 ÷ 6,905 = 26.24

2 Click competitor name to see calculations.

Solvency ratio Description The company
Interest coverage ratio A solvency ratio calculated as EBIT divided by interest payments. Shockwave Medical Inc. interest coverage ratio improved from 2021 to 2022 but then slightly deteriorated from 2022 to 2023 not reaching 2021 level.

Fixed Charge Coverage

Shockwave Medical Inc., fixed charge coverage calculation, comparison to benchmarks

Microsoft Excel
Dec 31, 2023 Dec 31, 2022 Dec 31, 2021 Dec 31, 2020 Dec 31, 2019
Selected Financial Data (US$ in thousands)
Net income (loss) 147,278 215,996 (9,136) (65,699) (51,109)
Add: Income tax expense 27,003 (95,168) 301 80 62
Add: Interest expense 6,905 1,886 1,096 1,212 944
Earnings before interest and tax (EBIT) 181,186 122,714 (7,739) (64,407) (50,103)
Add: Operating lease cost 5,110 4,667 2,891 2,208 1,200
Earnings before fixed charges and tax 186,296 127,381 (4,848) (62,199) (48,903)
 
Interest expense 6,905 1,886 1,096 1,212 944
Operating lease cost 5,110 4,667 2,891 2,208 1,200
Fixed charges 12,015 6,553 3,987 3,420 2,144
Solvency Ratio
Fixed charge coverage1 15.51 19.44 -1.22 -18.19 -22.81
Benchmarks
Fixed Charge Coverage, Competitors2
Abbott Laboratories 7.71 10.10 10.21 6.68 5.14
Cigna Group 4.64 6.87 5.61 7.84 4.67
CVS Health Corp. 3.15 2.16 3.03 2.75 2.56
Elevance Health Inc. 7.51 8.82 8.48 6.10 7.34
Humana Inc. 6.20 7.10 8.05 12.02 9.76
Intuitive Surgical Inc. 74.09 63.52 93.66 58.48 79.65
Medtronic PLC 6.90 7.79 4.31 3.98 3.97
UnitedHealth Group Inc. 7.27 8.77 8.80 8.51 7.65
Fixed Charge Coverage, Sector
Health Care Equipment & Services 5.70 6.16 5.95 5.51 4.75
Fixed Charge Coverage, Industry
Health Care 5.47 8.87 8.60 5.72 6.62

Based on: 10-K (reporting date: 2023-12-31), 10-K (reporting date: 2022-12-31), 10-K (reporting date: 2021-12-31), 10-K (reporting date: 2020-12-31), 10-K (reporting date: 2019-12-31).

1 2023 Calculation
Fixed charge coverage = Earnings before fixed charges and tax ÷ Fixed charges
= 186,296 ÷ 12,015 = 15.51

2 Click competitor name to see calculations.

Solvency ratio Description The company
Fixed charge coverage ratio A solvency ratio calculated as earnings before fixed charges and tax divided by fixed charges. Shockwave Medical Inc. fixed charge coverage ratio improved from 2021 to 2022 but then slightly deteriorated from 2022 to 2023.