Interpretation of Incidence Rates Data
Incidence Rate Report by State
All Cancer Sites (All Stages^), 2014-2018
All Races (includes Hispanic), Both Sexes, All Ages
Sorted by Count
Explanation of Column HeadersObjective - The objective of *** is from the Healthy People 2020 project done by the Centers for Disease Control and Prevention.
Incidence Rate (95% Confidence Interval) - The incidence rate is based upon 100,000 people and is an annual rate (or average annual rate) based on the time period indicated. Rates are age-adjusted by 5-year age groups to the 2000 U.S. standard million population.Recent Trends - This is an interpretation of the AAPC/APC:
- Rising when 95% confidence interval of AAPC/APC is above 0.
- Stable when 95% confidence interval of AAPC/APC includes 0.
- Falling when 95% confidence interval of AAPC/APC is below 0.
AAPC/APC (95% Confidence Interval) - the change in rate over time
- Average Annual Percent Change - AAPCs are based upon APCs that were calculated by Joinpoint Regression Program
- Annual Percent Change - APCs calculated in SEER*Stat.
Other Notes
- Larger confidence intervals indicate less stability of the data. This is often due to low counts that are not quite low enough to be suppressed.
- Data is currently being suppressed if there are fewer than 16 counts for the time period.
Line by Line Interpretation of the Report
US (SEER+NPCR)1
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 448.6 with a 95% confidence interval from 448.3 to 448.9 and 1,703,249 average annual cases over 2014-2018.
- CI*Rank⋔ : N/A
- Recent Trend : The trend is falling
because the trend is -0.9 with a 95% confidence interval from -1.1 to -0.7.
California7
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 402.4 with a 95% confidence interval from 401.6 to 403.3 and 171,164 average annual cases over 2014-2018.
- CI*Rank⋔ : 46 (45, 48)
- Recent Trend : The trend is falling
because the trend is -1.4 with a 95% confidence interval from -1.7 to -1.2.
Florida6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 460.2 with a 95% confidence interval from 459.0 to 461.3 and 130,868 average annual cases over 2014-2018.
- CI*Rank⋔ : 24 (23, 28)
- Recent Trend : The trend is stable
because the trend is -1.8 with a 95% confidence interval from -3.7 to 0.1.
New York7
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 483.1 with a 95% confidence interval from 481.8 to 484.3 and 114,167 average annual cases over 2014-2018.
- CI*Rank⋔ : 5 (3, 8)
- Recent Trend : The trend is falling
because the trend is -0.7 with a 95% confidence interval from -1.0 to -0.5.
Texas6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 411.2 with a 95% confidence interval from 410.1 to 412.3 and 114,140 average annual cases over 2014-2018.
- CI*Rank⋔ : 43 (42, 45)
- Recent Trend : The trend is falling
because the trend is -0.5 with a 95% confidence interval from -0.8 to -0.2.
Pennsylvania6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 480.0 with a 95% confidence interval from 478.5 to 481.5 and 79,777 average annual cases over 2014-2018.
- CI*Rank⋔ : 7 (5, 11)
- Recent Trend : The trend is falling
because the trend is -1.1 with a 95% confidence interval from -1.5 to -0.6.
Illinois6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 466.8 with a 95% confidence interval from 465.2 to 468.4 and 69,570 average annual cases over 2014-2018.
- CI*Rank⋔ : 20 (15, 23)
- Recent Trend : The trend is stable
because the trend is -0.4 with a 95% confidence interval from -1.1 to 0.4.
Ohio6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 467.5 with a 95% confidence interval from 465.9 to 469.1 and 67,455 average annual cases over 2014-2018.
- CI*Rank⋔ : 19 (14, 23)
- Recent Trend : The trend is falling
because the trend is -0.3 with a 95% confidence interval from -0.5 to -0.1.
North Carolina6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 468.9 with a 95% confidence interval from 467.2 to 470.7 and 56,784 average annual cases over 2014-2018.
- CI*Rank⋔ : 15 (13, 21)
- Recent Trend : The trend is falling
because the trend is -0.6 with a 95% confidence interval from -0.8 to -0.4.
Michigan5
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 448.8 with a 95% confidence interval from 447.1 to 450.5 and 55,623 average annual cases over 2014-2018.
- CI*Rank⋔ : 36 (32, 37)
- Recent Trend : The trend is falling
because the trend is -1.1 with a 95% confidence interval from -1.3 to -0.9.
New Jersey7
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 486.7 with a 95% confidence interval from 484.8 to 488.6 and 52,514 average annual cases over 2014-2018.
- CI*Rank⋔ : 2 (2, 4)
- Recent Trend : The trend is falling
because the trend is -0.6 with a 95% confidence interval from -0.8 to -0.5.
Georgia7
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 468.5 with a 95% confidence interval from 466.7 to 470.4 and 51,965 average annual cases over 2014-2018.
- CI*Rank⋔ : 16 (13, 22)
- Recent Trend : The trend is falling
because the trend is -0.2 with a 95% confidence interval from -0.3 to -0.1.
Virginia6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 411.0 with a 95% confidence interval from 409.2 to 412.8 and 40,096 average annual cases over 2014-2018.
- CI*Rank⋔ : 44 (42, 45)
- Recent Trend : The trend is falling
because the trend is -1.5 with a 95% confidence interval from -1.8 to -1.1.
Massachusetts7
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 457.8 with a 95% confidence interval from 455.7 to 459.9 and 38,103 average annual cases over 2014-2018.
- CI*Rank⋔ : 28 (24, 30)
- Recent Trend : The trend is stable
because the trend is -1.6 with a 95% confidence interval from -4.9 to 1.8.
Tennessee6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 466.0 with a 95% confidence interval from 463.8 to 468.2 and 37,470 average annual cases over 2014-2018.
- CI*Rank⋔ : 21 (15, 24)
- Recent Trend : The trend is falling
because the trend is -0.4 with a 95% confidence interval from -0.6 to -0.1.
Washington5
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 442.4 with a 95% confidence interval from 440.3 to 444.5 and 37,094 average annual cases over 2014-2018.
- CI*Rank⋔ : 38 (37, 38)
- Recent Trend : The trend is falling
because the trend is -1.1 with a 95% confidence interval from -1.3 to -0.9.
Indiana6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 457.9 with a 95% confidence interval from 455.7 to 460.0 and 35,470 average annual cases over 2014-2018.
- CI*Rank⋔ : 26 (23, 30)
- Recent Trend : The trend is stable
because the trend is -2.0 with a 95% confidence interval from -3.9 to 0.0.
Missouri6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 452.3 with a 95% confidence interval from 450.1 to 454.6 and 33,755 average annual cases over 2014-2018.
- CI*Rank⋔ : 32 (28, 35)
- Recent Trend : The trend is falling
because the trend is -0.5 with a 95% confidence interval from -0.8 to -0.3.
Wisconsin6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 468.5 with a 95% confidence interval from 466.2 to 470.8 and 33,416 average annual cases over 2014-2018.
- CI*Rank⋔ : 17 (13, 22)
- Recent Trend : The trend is falling
because the trend is -0.2 with a 95% confidence interval from -0.4 to -0.1.
Arizona6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 385.7 with a 95% confidence interval from 383.8 to 387.6 and 32,375 average annual cases over 2014-2018.
- CI*Rank⋔ : 50 (50, 50)
- Recent Trend : The trend is falling
because the trend is -0.9 with a 95% confidence interval from -1.0 to -0.7.
Maryland6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 452.5 with a 95% confidence interval from 450.2 to 454.8 and 31,791 average annual cases over 2014-2018.
- CI*Rank⋔ : 31 (28, 35)
- Recent Trend : The trend is falling
because the trend is -0.6 with a 95% confidence interval from -0.8 to -0.3.
Minnesota6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 469.5 with a 95% confidence interval from 467.1 to 472.0 and 30,506 average annual cases over 2014-2018.
- CI*Rank⋔ : 14 (12, 21)
- Recent Trend : The trend is stable
because the trend is -0.2 with a 95% confidence interval from -0.5 to 0.0.
South Carolina6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 449.6 with a 95% confidence interval from 447.2 to 452.1 and 27,846 average annual cases over 2014-2018.
- CI*Rank⋔ : 35 (30, 37)
- Recent Trend : The trend is falling
because the trend is -2.0 with a 95% confidence interval from -3.6 to -0.5.
Kentucky7
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 517.8 with a 95% confidence interval from 515.0 to 520.6 and 27,645 average annual cases over 2014-2018.
- CI*Rank⋔ : 1 (1, 1)
- Recent Trend : The trend is stable
because the trend is -1.0 with a 95% confidence interval from -1.9 to 0.0.
Alabama6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 450.8 with a 95% confidence interval from 448.3 to 453.2 and 26,900 average annual cases over 2014-2018.
- CI*Rank⋔ : 33 (29, 37)
- Recent Trend : The trend is falling
because the trend is -0.7 with a 95% confidence interval from -1.1 to -0.3.
Louisiana7
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 482.4 with a 95% confidence interval from 479.7 to 485.1 and 25,875 average annual cases over 2014-2018.
- CI*Rank⋔ : 6 (2, 10)
- Recent Trend : The trend is falling
because the trend is -0.5 with a 95% confidence interval from -0.9 to -0.2.
Colorado6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 396.6 with a 95% confidence interval from 394.3 to 399.0 and 23,773 average annual cases over 2014-2018.
- CI*Rank⋔ : 49 (47, 49)
- Recent Trend : The trend is falling
because the trend is -1.4 with a 95% confidence interval from -1.8 to -1.1.
Oregon6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 430.5 with a 95% confidence interval from 427.9 to 433.2 and 21,877 average annual cases over 2014-2018.
- CI*Rank⋔ : 39 (39, 40)
- Recent Trend : The trend is falling
because the trend is -0.9 with a 95% confidence interval from -1.2 to -0.7.
Connecticut7
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 465.1 with a 95% confidence interval from 462.2 to 468.0 and 21,039 average annual cases over 2014-2018.
- CI*Rank⋔ : 22 (15, 24)
- Recent Trend : The trend is falling
because the trend is -1.3 with a 95% confidence interval from -1.5 to -1.1.
Oklahoma6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 450.2 with a 95% confidence interval from 447.4 to 453.1 and 20,358 average annual cases over 2014-2018.
- CI*Rank⋔ : 34 (29, 37)
- Recent Trend : The trend is stable
because the trend is -0.3 with a 95% confidence interval from -0.9 to 0.2.
Iowa7
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 484.1 with a 95% confidence interval from 480.9 to 487.3 and 18,583 average annual cases over 2014-2018.
- CI*Rank⋔ : 3 (2, 9)
- Recent Trend : The trend is stable
because the trend is -0.2 with a 95% confidence interval from -0.3 to 0.0.
Arkansas6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 479.0 with a 95% confidence interval from 475.7 to 482.2 and 17,464 average annual cases over 2014-2018.
- CI*Rank⋔ : 10 (4, 12)
- Recent Trend : The trend is stable
because the trend is 0.6 with a 95% confidence interval from -0.4 to 1.6.
Mississippi6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 474.4 with a 95% confidence interval from 471.1 to 477.7 and 16,616 average annual cases over 2014-2018.
- CI*Rank⋔ : 12 (9, 14)
- Recent Trend : * Data has been suppressed to ensure confidentiality and stability of rate estimates. Counts are suppressed if fewer than 16 records were reported in a specific area-sex-race category. If an average count of 3 is shown, the total number of cases for the time period is 16 or more which exceeds suppression threshold (but is rounded to 3).
Puerto Rico6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 356.3 with a 95% confidence interval from 353.7 to 358.9 and 15,841 average annual cases over 2014-2018.
- CI*Rank⋔ : N/A
- Recent Trend : The trend is stable
because the trend is -1.0 with a 95% confidence interval from -6.9 to 5.2.
Kansas6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 457.8 with a 95% confidence interval from 454.5 to 461.1 and 15,348 average annual cases over 2014-2018.
- CI*Rank⋔ : 27 (23, 31)
- Recent Trend : The trend is falling
because the trend is -0.7 with a 95% confidence interval from -1.1 to -0.4.
West Virginia6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 483.5 with a 95% confidence interval from 479.5 to 487.6 and 12,028 average annual cases over 2014-2018.
- CI*Rank⋔ : 4 (2, 10)
- Recent Trend : The trend is falling
because the trend is -0.3 with a 95% confidence interval from -0.4 to -0.1.
Utah7
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 405.4 with a 95% confidence interval from 401.9 to 408.9 and 10,831 average annual cases over 2014-2018.
- CI*Rank⋔ : 45 (44, 48)
- Recent Trend : The trend is falling
because the trend is -0.5 with a 95% confidence interval from -0.7 to -0.2.
Nevada6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 398.8 with a 95% confidence interval from 395.3 to 402.3 and 10,567 average annual cases over 2014-2018.
- CI*Rank⋔ : 48 (46, 49)
- Recent Trend : * Data has been suppressed to ensure confidentiality and stability of rate estimates. Counts are suppressed if fewer than 16 records were reported in a specific area-sex-race category. If an average count of 3 is shown, the total number of cases for the time period is 16 or more which exceeds suppression threshold (but is rounded to 3).
Nebraska6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 467.7 with a 95% confidence interval from 463.5 to 471.8 and 10,261 average annual cases over 2014-2018.
- CI*Rank⋔ : 18 (12, 24)
- Recent Trend : The trend is rising
because the trend is 1.0 with a 95% confidence interval from 0.2 to 1.8.
New Mexico7
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 373.2 with a 95% confidence interval from 369.8 to 376.7 and 9,433 average annual cases over 2014-2018.
- CI*Rank⋔ : 51 (51, 51)
- Recent Trend : The trend is falling
because the trend is -1.3 with a 95% confidence interval from -1.7 to -0.9.
Maine6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 476.0 with a 95% confidence interval from 471.4 to 480.6 and 8,998 average annual cases over 2014-2018.
- CI*Rank⋔ : 11 (5, 15)
- Recent Trend : The trend is stable
because the trend is -0.4 with a 95% confidence interval from -0.9 to 0.1.
Idaho7
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 445.1 with a 95% confidence interval from 440.8 to 449.5 and 8,515 average annual cases over 2014-2018.
- CI*Rank⋔ : 37 (32, 38)
- Recent Trend : The trend is stable
because the trend is -0.7 with a 95% confidence interval from -2.6 to 1.2.
New Hampshire6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 479.3 with a 95% confidence interval from 474.6 to 484.1 and 8,436 average annual cases over 2014-2018.
- CI*Rank⋔ : 9 (3, 13)
- Recent Trend : The trend is falling
because the trend is -0.8 with a 95% confidence interval from -1.0 to -0.6.
Hawaii7
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 415.5 with a 95% confidence interval from 411.1 to 419.9 and 7,393 average annual cases over 2014-2018.
- CI*Rank⋔ : 42 (40, 44)
- Recent Trend : The trend is falling
because the trend is -0.2 with a 95% confidence interval from -0.3 to -0.1.
Rhode Island6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 472.8 with a 95% confidence interval from 467.4 to 478.2 and 6,272 average annual cases over 2014-2018.
- CI*Rank⋔ : 13 (7, 22)
- Recent Trend : The trend is falling
because the trend is -1.4 with a 95% confidence interval from -1.9 to -0.9.
Montana6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 462.9 with a 95% confidence interval from 457.6 to 468.3 and 6,270 average annual cases over 2014-2018.
- CI*Rank⋔ : 23 (14, 29)
- Recent Trend : The trend is falling
because the trend is -0.5 with a 95% confidence interval from -0.7 to -0.3.
Delaware6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 479.6 with a 95% confidence interval from 474.0 to 485.3 and 5,893 average annual cases over 2014-2018.
- CI*Rank⋔ : 8 (2, 13)
- Recent Trend : The trend is falling
because the trend is -2.7 with a 95% confidence interval from -4.6 to -0.9.
South Dakota6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 459.1 with a 95% confidence interval from 453.1 to 465.3 and 4,719 average annual cases over 2014-2018.
- CI*Rank⋔ : 25 (18, 33)
- Recent Trend : The trend is stable
because the trend is -0.2 with a 95% confidence interval from -0.5 to 0.2.
Vermont6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 457.4 with a 95% confidence interval from 450.7 to 464.2 and 3,841 average annual cases over 2014-2018.
- CI*Rank⋔ : 29 (18, 36)
- Recent Trend : The trend is falling
because the trend is -0.8 with a 95% confidence interval from -1.1 to -0.5.
North Dakota6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 453.2 with a 95% confidence interval from 446.6 to 459.9 and 3,822 average annual cases over 2014-2018.
- CI*Rank⋔ : 30 (23, 37)
- Recent Trend : The trend is falling
because the trend is -0.3 with a 95% confidence interval from -0.6 to -0.1.
Alaska6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 418.6 with a 95% confidence interval from 411.4 to 425.8 and 2,952 average annual cases over 2014-2018.
- CI*Rank⋔ : 41 (40, 44)
- Recent Trend : The trend is falling
because the trend is -1.5 with a 95% confidence interval from -1.7 to -1.2.
District of Columbia6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 426.0 with a 95% confidence interval from 418.9 to 433.2 and 2,867 average annual cases over 2014-2018.
- CI*Rank⋔ : 40 (39, 42)
- Recent Trend : The trend is stable
because the trend is -1.1 with a 95% confidence interval from -5.3 to 3.3.
Wyoming6
- Met Healthy People Objective of ***? : ***
- Rate : The incidence rate is 402.1 with a 95% confidence interval from 395.2 to 409.1 and 2,764 average annual cases over 2014-2018.
- CI*Rank⋔ : 47 (43, 49)
- Recent Trend : The trend is falling
because the trend is -0.9 with a 95% confidence interval from -1.2 to -0.6.
Notes:
Created by statecancerprofiles.cancer.gov on 05/20/2022 10:58 am.
State Cancer Registries may provide more current or more local data.
Trend
Rising when 95% confidence interval of average annual percent change is above 0.
Stable when 95% confidence interval of average annual percent change includes 0.
Falling when 95% confidence interval of average annual percent change is below 0.
Rising when 95% confidence interval of average annual percent change is above 0.
Stable when 95% confidence interval of average annual percent change includes 0.
Falling when 95% confidence interval of average annual percent change is below 0.
⋔ Results presented with the CI*Rank statistics help show the usefulness of ranks. For example, ranks for relatively rare diseases or less populated areas may be essentially meaningless because of their large variability, but ranks for more common diseases in densely populated regions can be very useful. More information about methodology can be found on the CI*Rank website.
† Incidence rates (cases per 100,000 population per year) are age-adjusted to the 2000 US standard population (19 age groups: <1, 1-4, 5-9, ... , 80-84, 85+). Rates are for invasive cancer only (except for bladder cancer which is invasive and in situ) or unless otherwise specified. Rates calculated using SEER*Stat. Population counts for denominators are based on Census populations as modified by NCI. The 1969-2018 US Population Data File is used for SEER and NPCR incidence rates.
‡ Incidence data come from different sources. Due to different years of data availability, most of the trends are AAPCs based on APCs but some are APCs calculated in SEER*Stat. Please refer to the source for each area for additional information.
Rates and trends are computed using different standards for malignancy. For more information see malignant.html.
^ All Stages refers to any stage in the Surveillance, Epidemiology, and End Results (SEER) summary stage.
*** No Healthy People 2020 Objective for this cancer.
Healthy People 2020 Objectives provided by the Centers for Disease Control and Prevention.
* Data has been suppressed to ensure confidentiality and stability of rate estimates. Counts are suppressed if fewer than 16 records were reported in a specific area-sex-race category. If an average count of 3 is shown, the total number of cases for the time period is 16 or more which exceeds suppression threshold (but is rounded to 3).
1 Source: National Program of Cancer Registries and Surveillance, Epidemiology, and End Results SEER*Stat Database (2001-2018) - United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Based on the 2020 submission.
5 Source: National Program of Cancer Registries and Surveillance, Epidemiology, and End Results SEER*Stat Database (2001-2018) - United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Based on the 2020 submission.
6 Source: National Program of Cancer Registries SEER*Stat Database (2001-2018) - United States Department of Health and Human Services, Centers for Disease Control and Prevention (based on the 2020 submission).
7 Source: SEER November 2020 submission.
8 Source: Incidence data provided by the SEER Program. AAPCs are calculated by the Joinpoint Regression Program and are based on APCs. Data are age-adjusted to the 2000 US standard population (19 age groups: <1, 1-4, 5-9, ... , 80-84,85+). Rates are for invasive cancer only (except for bladder cancer which is invasive and in situ) or unless otherwise specified. Population counts for denominators are based on Census populations as modifed by NCI. The 1969-2018 US Population Data File is used with SEER November 2020 data.
Interpret Rankings provides insight into interpreting cancer incidence statistics. When the population size for a denominator is small, the rates may be unstable. A rate is unstable when a small change in the numerator (e.g., only one or two additional cases) has a dramatic effect on the calculated rate.
Data for United States does not include Puerto Rico.