State Cancer Profiles

Interpretation of Incidence Rates Data

Incidence Rate Report for Florida by County

Lung & Bronchus (Late Stage^), 2017-2021

All Races (includes Hispanic), Both Sexes, All Ages

Sorted by Count

Explanation of Column Headers

Objective - 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.

Percent of Cases with Late Stage - This is the number of late stages cases compared to the number of cases for all stages.

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

Florida⁶

• 2023 Rural-Urban Continuum Codes Φ : N/A
• Rate : The incidence rate is 34.6 with a 95% confidence interval from 34.3 to 34.9 and 11,291 average annual cases over 2017-2021.
• CI*Rank ⋔ : N/A
• Percent of Cases with Late Stage : 63.3

US (SEER+NPCR)¹

• 2023 Rural-Urban Continuum Codes Φ : N/A
• Rate : The incidence rate is 34.3 with a 95% confidence interval from 34.2 to 34.4 and 140,561 average annual cases over 2017-2021.
• CI*Rank ⋔ : N/A
• Percent of Cases with Late Stage : 64.9

Lafayette County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 48.2 with a 95% confidence interval from 31.4 to 71.8 and 5 average annual cases over 2017-2021.
• CI*Rank ⋔ : 15 (2, 67)
• Percent of Cases with Late Stage : 61.9

Liberty County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 56.3 with a 95% confidence interval from 36.5 to 83.7 and 5 average annual cases over 2017-2021.
• CI*Rank ⋔ : 6 (2, 66)
• Percent of Cases with Late Stage : 65.0

Jefferson County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 30.1 with a 95% confidence interval from 20.9 to 43.1 and 8 average annual cases over 2017-2021.
• CI*Rank ⋔ : 60 (17, 67)
• Percent of Cases with Late Stage : 62.3

Franklin County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 36.1 with a 95% confidence interval from 25.6 to 50.8 and 8 average annual cases over 2017-2021.
• CI*Rank ⋔ : 47 (7, 67)
• Percent of Cases with Late Stage : 65.6

Holmes County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 29.0 with a 95% confidence interval from 20.7 to 40.0 and 8 average annual cases over 2017-2021.
• CI*Rank ⋔ : 63 (23, 67)
• Percent of Cases with Late Stage : 46.7

Calhoun County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 44.0 with a 95% confidence interval from 31.7 to 60.1 and 9 average annual cases over 2017-2021.
• CI*Rank ⋔ : 24 (2, 66)
• Percent of Cases with Late Stage : 55.1

Hamilton County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 45.1 with a 95% confidence interval from 32.5 to 61.5 and 9 average annual cases over 2017-2021.
• CI*Rank ⋔ : 21 (2, 65)
• Percent of Cases with Late Stage : 62.9

Glades County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 40.6 with a 95% confidence interval from 29.9 to 55.7 and 10 average annual cases over 2017-2021.
• CI*Rank ⋔ : 34 (4, 66)
• Percent of Cases with Late Stage : 63.6

Madison County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 36.8 with a 95% confidence interval from 27.1 to 49.2 and 10 average annual cases over 2017-2021.
• CI*Rank ⋔ : 45 (7, 67)
• Percent of Cases with Late Stage : 60.0

Gulf County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 42.0 with a 95% confidence interval from 31.5 to 55.9 and 11 average annual cases over 2017-2021.
• CI*Rank ⋔ : 30 (4, 66)
• Percent of Cases with Late Stage : 71.8

Hardee County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 43.1 with a 95% confidence interval from 33.3 to 55.2 and 13 average annual cases over 2017-2021.
• CI*Rank ⋔ : 28 (4, 63)
• Percent of Cases with Late Stage : 70.2

Washington County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 38.5 with a 95% confidence interval from 29.7 to 49.3 and 14 average annual cases over 2017-2021.
• CI*Rank ⋔ : 39 (7, 66)
• Percent of Cases with Late Stage : 62.4

Gilchrist County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 48.2 with a 95% confidence interval from 37.3 to 61.9 and 14 average annual cases over 2017-2021.
• CI*Rank ⋔ : 14 (2, 59)
• Percent of Cases with Late Stage : 57.5

Baker County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 48.5 with a 95% confidence interval from 38.4 to 60.6 and 16 average annual cases over 2017-2021.
• CI*Rank ⋔ : 13 (2, 58)
• Percent of Cases with Late Stage : 67.8

Dixie County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 59.1 with a 95% confidence interval from 46.8 to 74.3 and 17 average annual cases over 2017-2021.
• CI*Rank ⋔ : 4 (2, 34)
• Percent of Cases with Late Stage : 66.4

Hendry County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 43.5 with a 95% confidence interval from 35.0 to 53.6 and 18 average annual cases over 2017-2021.
• CI*Rank ⋔ : 26 (5, 61)
• Percent of Cases with Late Stage : 69.5

Bradford County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 51.6 with a 95% confidence interval from 41.8 to 63.3 and 20 average annual cases over 2017-2021.
• CI*Rank ⋔ : 9 (2, 46)
• Percent of Cases with Late Stage : 69.2

Wakulla County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 46.1 with a 95% confidence interval from 37.3 to 56.6 and 20 average annual cases over 2017-2021.
• CI*Rank ⋔ : 18 (3, 57)
• Percent of Cases with Late Stage : 65.6

Taylor County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 65.3 with a 95% confidence interval from 53.1 to 79.7 and 21 average annual cases over 2017-2021.
• CI*Rank ⋔ : 2 (2, 20)
• Percent of Cases with Late Stage : 70.7

DeSoto County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 41.5 with a 95% confidence interval from 33.9 to 50.6 and 22 average annual cases over 2017-2021.
• CI*Rank ⋔ : 31 (7, 61)
• Percent of Cases with Late Stage : 63.4

Gadsden County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 38.0 with a 95% confidence interval from 31.4 to 45.8 and 24 average annual cases over 2017-2021.
• CI*Rank ⋔ : 42 (12, 63)
• Percent of Cases with Late Stage : 62.9

Union County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 133.4 with a 95% confidence interval from 111.5 to 158.6 and 28 average annual cases over 2017-2021.
• CI*Rank ⋔ : 1 (1, 1)
• Percent of Cases with Late Stage : 79.3

Jackson County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 38.0 with a 95% confidence interval from 32.0 to 45.1 and 28 average annual cases over 2017-2021.
• CI*Rank ⋔ : 41 (14, 62)
• Percent of Cases with Late Stage : 68.1

Okeechobee County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 53.4 with a 95% confidence interval from 45.1 to 62.8 and 31 average annual cases over 2017-2021.
• CI*Rank ⋔ : 7 (2, 33)
• Percent of Cases with Late Stage : 64.0

Suwannee County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 50.9 with a 95% confidence interval from 43.4 to 59.4 and 35 average annual cases over 2017-2021.
• CI*Rank ⋔ : 10 (3, 35)
• Percent of Cases with Late Stage : 65.5

Walton County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 37.7 with a 95% confidence interval from 32.7 to 43.4 and 43 average annual cases over 2017-2021.
• CI*Rank ⋔ : 43 (18, 60)
• Percent of Cases with Late Stage : 69.9

Levy County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 57.1 with a 95% confidence interval from 49.6 to 65.8 and 44 average annual cases over 2017-2021.
• CI*Rank ⋔ : 5 (2, 21)
• Percent of Cases with Late Stage : 69.2

Monroe County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 30.5 with a 95% confidence interval from 26.6 to 35.0 and 46 average annual cases over 2017-2021.
• CI*Rank ⋔ : 59 (41, 66)
• Percent of Cases with Late Stage : 69.3

Columbia County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 51.9 with a 95% confidence interval from 45.7 to 58.9 and 53 average annual cases over 2017-2021.
• CI*Rank ⋔ : 8 (3, 29)
• Percent of Cases with Late Stage : 66.1

Nassau County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 45.8 with a 95% confidence interval from 40.9 to 51.3 and 68 average annual cases over 2017-2021.
• CI*Rank ⋔ : 19 (6, 40)
• Percent of Cases with Late Stage : 65.0

Putnam County⁶

• 2023 Rural-Urban Continuum Codes Φ : Rural
• Rate : The incidence rate is 64.5 with a 95% confidence interval from 58.1 to 71.6 and 79 average annual cases over 2017-2021.
• CI*Rank ⋔ : 3 (2, 8)
• Percent of Cases with Late Stage : 65.9

Highlands County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 38.1 with a 95% confidence interval from 34.2 to 42.4 and 86 average annual cases over 2017-2021.
• CI*Rank ⋔ : 40 (21, 57)
• Percent of Cases with Late Stage : 61.6

Leon County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 30.1 with a 95% confidence interval from 27.4 to 33.1 and 95 average annual cases over 2017-2021.
• CI*Rank ⋔ : 61 (48, 64)
• Percent of Cases with Late Stage : 62.7

Flagler County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 40.8 with a 95% confidence interval from 37.0 to 45.0 and 97 average annual cases over 2017-2021.
• CI*Rank ⋔ : 33 (16, 51)
• Percent of Cases with Late Stage : 63.8

Alachua County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 32.8 with a 95% confidence interval from 29.9 to 35.9 and 98 average annual cases over 2017-2021.
• CI*Rank ⋔ : 55 (40, 63)
• Percent of Cases with Late Stage : 62.6

Bay County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 39.0 with a 95% confidence interval from 35.6 to 42.7 and 100 average annual cases over 2017-2021.
• CI*Rank ⋔ : 38 (21, 53)
• Percent of Cases with Late Stage : 61.8

Okaloosa County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 42.1 with a 95% confidence interval from 38.6 to 45.9 and 111 average annual cases over 2017-2021.
• CI*Rank ⋔ : 29 (15, 43)
• Percent of Cases with Late Stage : 67.0

Santa Rosa County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 47.8 with a 95% confidence interval from 43.9 to 52.0 and 113 average annual cases over 2017-2021.
• CI*Rank ⋔ : 16 (6, 31)
• Percent of Cases with Late Stage : 68.5

Martin County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 34.4 with a 95% confidence interval from 31.5 to 37.5 and 117 average annual cases over 2017-2021.
• CI*Rank ⋔ : 51 (35, 61)
• Percent of Cases with Late Stage : 61.4

Osceola County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 31.8 with a 95% confidence interval from 29.4 to 34.5 and 129 average annual cases over 2017-2021.
• CI*Rank ⋔ : 58 (45, 63)
• Percent of Cases with Late Stage : 68.4

Clay County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 47.0 with a 95% confidence interval from 43.4 to 50.9 and 131 average annual cases over 2017-2021.
• CI*Rank ⋔ : 17 (7, 32)
• Percent of Cases with Late Stage : 67.3

Sumter County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 34.7 with a 95% confidence interval from 30.9 to 39.1 and 133 average annual cases over 2017-2021.
• CI*Rank ⋔ : 50 (31, 62)
• Percent of Cases with Late Stage : 59.9

St. Johns County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 33.2 with a 95% confidence interval from 30.7 to 35.9 and 135 average annual cases over 2017-2021.
• CI*Rank ⋔ : 54 (40, 61)
• Percent of Cases with Late Stage : 63.3

Indian River County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 40.2 with a 95% confidence interval from 37.0 to 43.7 and 139 average annual cases over 2017-2021.
• CI*Rank ⋔ : 35 (20, 48)
• Percent of Cases with Late Stage : 62.2

Charlotte County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 34.2 with a 95% confidence interval from 31.5 to 37.2 and 158 average annual cases over 2017-2021.
• CI*Rank ⋔ : 52 (36, 60)
• Percent of Cases with Late Stage : 54.1

Hernando County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 44.9 with a 95% confidence interval from 41.8 to 48.3 and 165 average annual cases over 2017-2021.
• CI*Rank ⋔ : 22 (10, 36)
• Percent of Cases with Late Stage : 60.9

Citrus County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 50.5 with a 95% confidence interval from 46.8 to 54.5 and 175 average annual cases over 2017-2021.
• CI*Rank ⋔ : 11 (5, 23)
• Percent of Cases with Late Stage : 65.3

Collier County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 22.6 with a 95% confidence interval from 21.0 to 24.4 and 175 average annual cases over 2017-2021.
• CI*Rank ⋔ : 67 (65, 67)
• Percent of Cases with Late Stage : 60.6

Seminole County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 31.9 with a 95% confidence interval from 29.9 to 34.1 and 185 average annual cases over 2017-2021.
• CI*Rank ⋔ : 57 (46, 62)
• Percent of Cases with Late Stage : 64.1

St. Lucie County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 36.7 with a 95% confidence interval from 34.4 to 39.1 and 205 average annual cases over 2017-2021.
• CI*Rank ⋔ : 46 (31, 54)
• Percent of Cases with Late Stage : 61.1

Escambia County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 50.0 with a 95% confidence interval from 46.9 to 53.2 and 211 average annual cases over 2017-2021.
• CI*Rank ⋔ : 12 (6, 22)
• Percent of Cases with Late Stage : 68.5

Lake County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 37.5 with a 95% confidence interval from 35.4 to 39.8 and 261 average annual cases over 2017-2021.
• CI*Rank ⋔ : 44 (30, 51)
• Percent of Cases with Late Stage : 61.8

Manatee County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 34.0 with a 95% confidence interval from 32.1 to 36.0 and 262 average annual cases over 2017-2021.
• CI*Rank ⋔ : 53 (40, 60)
• Percent of Cases with Late Stage : 67.0

Marion County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 44.4 with a 95% confidence interval from 42.1 to 46.8 and 314 average annual cases over 2017-2021.
• CI*Rank ⋔ : 23 (13, 34)
• Percent of Cases with Late Stage : 61.7

Sarasota County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 32.5 with a 95% confidence interval from 30.7 to 34.3 and 332 average annual cases over 2017-2021.
• CI*Rank ⋔ : 56 (46, 61)
• Percent of Cases with Late Stage : 59.6

Pasco County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 43.3 with a 95% confidence interval from 41.4 to 45.4 and 383 average annual cases over 2017-2021.
• CI*Rank ⋔ : 27 (16, 35)
• Percent of Cases with Late Stage : 61.9

Brevard County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 39.0 with a 95% confidence interval from 37.3 to 40.8 and 410 average annual cases over 2017-2021.
• CI*Rank ⋔ : 37 (27, 46)
• Percent of Cases with Late Stage : 61.0

Orange County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 29.2 with a 95% confidence interval from 28.0 to 30.6 and 413 average annual cases over 2017-2021.
• CI*Rank ⋔ : 62 (56, 63)
• Percent of Cases with Late Stage : 66.3

Polk County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 41.3 with a 95% confidence interval from 39.5 to 43.1 and 432 average annual cases over 2017-2021.
• CI*Rank ⋔ : 32 (22, 40)
• Percent of Cases with Late Stage : 65.3

Volusia County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 45.4 with a 95% confidence interval from 43.5 to 47.5 and 441 average annual cases over 2017-2021.
• CI*Rank ⋔ : 20 (13, 30)
• Percent of Cases with Late Stage : 63.9

Duval County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 43.7 with a 95% confidence interval from 42.0 to 45.5 and 506 average annual cases over 2017-2021.
• CI*Rank ⋔ : 25 (16, 34)
• Percent of Cases with Late Stage : 66.0

Lee County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 35.9 with a 95% confidence interval from 34.4 to 37.4 and 524 average annual cases over 2017-2021.
• CI*Rank ⋔ : 48 (37, 54)
• Percent of Cases with Late Stage : 68.7

Hillsborough County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 34.9 with a 95% confidence interval from 33.6 to 36.2 and 581 average annual cases over 2017-2021.
• CI*Rank ⋔ : 49 (40, 55)
• Percent of Cases with Late Stage : 61.8

Broward County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 26.0 with a 95% confidence interval from 25.2 to 27.0 and 670 average annual cases over 2017-2021.
• CI*Rank ⋔ : 64 (61, 66)
• Percent of Cases with Late Stage : 63.1

Palm Beach County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 25.9 with a 95% confidence interval from 25.0 to 26.8 and 673 average annual cases over 2017-2021.
• CI*Rank ⋔ : 65 (61, 66)
• Percent of Cases with Late Stage : 58.1

Pinellas County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 40.1 with a 95% confidence interval from 38.7 to 41.5 and 696 average annual cases over 2017-2021.
• CI*Rank ⋔ : 36 (26, 43)
• Percent of Cases with Late Stage : 64.9

Miami-Dade County⁶

• 2023 Rural-Urban Continuum Codes Φ : Urban
• Rate : The incidence rate is 25.8 with a 95% confidence interval from 25.1 to 26.6 and 895 average annual cases over 2017-2021.
• CI*Rank ⋔ : 66 (61, 66)
• Percent of Cases with Late Stage : 62.7

Notes:
Created by statecancerprofiles.cancer.gov on 10/09/2024 4:29 pm.

State Cancer Registries may provide more current or more local data.
† 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 US Population Data File is used for SEER and NPCR incidence rates.

Rates are computed using cancers classified as malignant based on ICD-O-3. For more information see malignant.html.

^ Late Stage is defined as cases determined to be regional or distant. Due to changes in stage coding, Combined Summary Stage (2004+) is used for data from Surveillance, Epidemiology, and End Results (SEER) databases and Merged Summary Stage is used for data from National Program of Cancer Registries databases. Due to the increased complexity with staging, other staging variables maybe used if necessary.
Φ Rural-Urban Continuum Codes provided by the USDA.
Source: SEER and NPCR data. For more specific information please see the table.

Data for the United States does not include data from Indiana.
Data for the United States does not include Puerto Rico.