In the first quarter of 2021, overall Chapter 11 distress declined modestly from the prior quarter but remained significantly higher than a year earlier, while still below historical benchmark levels. Real estate distress fell sharply on both a quarterly and year-over-year basis, continuing to track well below long-term benchmarks. Health care services distress also declined modestly from the prior quarter but remained substantially elevated relative to historical norms, extending a multi-year pattern of outsized distress compared to other sectors.