Interpretation of Incidence Rates Data
Incidence Rate Report for North Dakota by County
Colon & Rectum (Late Stage^), 2017-2021
All Races (includes Hispanic), Both Sexes, Ages 50+
Sorted by Rate
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.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
North Dakota6
- 2023 Rural-Urban Continuum Codes Φ : N/A
- Rate : The incidence rate is 70.9 with a 95% confidence interval from 66.3 to 75.8 and 182 average annual cases over 2017-2021.
- CI*Rank ⋔ : N/A
- Percent of Cases with Late Stage : 60.9
US (SEER+NPCR)1
- 2023 Rural-Urban Continuum Codes Φ : N/A
- Rate : The incidence rate is 64.2 with a 95% confidence interval from 64.0 to 64.4 and 72,697 average annual cases over 2017-2021.
- CI*Rank ⋔ : N/A
- Percent of Cases with Late Stage : 59.1
Rolette County6
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : The incidence rate is 121.5 with a 95% confidence interval from 74.7 to 187.1 and 4 average annual cases over 2017-2021.
- CI*Rank ⋔ : 1 (1, 12)
- Percent of Cases with Late Stage : 61.1
Bottineau County6
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : The incidence rate is 114.5 with a 95% confidence interval from 65.4 to 185.9 and 3 average annual cases over 2017-2021.
- CI*Rank ⋔ : 2 (1, 14)
- Percent of Cases with Late Stage : 77.3
Ramsey County6
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : The incidence rate is 110.3 with a 95% confidence interval from 71.3 to 162.8 and 5 average annual cases over 2017-2021.
- CI*Rank ⋔ : 3 (1, 12)
- Percent of Cases with Late Stage : 65.0
Walsh County6
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : The incidence rate is 109.4 with a 95% confidence interval from 70.8 to 161.6 and 5 average annual cases over 2017-2021.
- CI*Rank ⋔ : 4 (1, 12)
- Percent of Cases with Late Stage : 72.2
Pembina County6
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : The incidence rate is 104.5 with a 95% confidence interval from 60.2 to 169.2 and 3 average annual cases over 2017-2021.
- CI*Rank ⋔ : 5 (1, 14)
- Percent of Cases with Late Stage : 60.7
Grand Forks County6
- 2023 Rural-Urban Continuum Codes Φ : Urban
- Rate : The incidence rate is 88.2 with a 95% confidence interval from 70.5 to 108.9 and 18 average annual cases over 2017-2021.
- CI*Rank ⋔ : 6 (2, 11)
- Percent of Cases with Late Stage : 67.7
Richland County6
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : The incidence rate is 77.6 with a 95% confidence interval from 50.8 to 114.2 and 6 average annual cases over 2017-2021.
- CI*Rank ⋔ : 7 (2, 15)
- Percent of Cases with Late Stage : 68.3
Williams County6
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : The incidence rate is 74.3 with a 95% confidence interval from 49.5 to 106.8 and 6 average annual cases over 2017-2021.
- CI*Rank ⋔ : 8 (2, 15)
- Percent of Cases with Late Stage : 57.1
Cass County6
- 2023 Rural-Urban Continuum Codes Φ : Urban
- Rate : The incidence rate is 74.0 with a 95% confidence interval from 63.3 to 85.9 and 36 average annual cases over 2017-2021.
- CI*Rank ⋔ : 9 (5, 12)
- Percent of Cases with Late Stage : 66.9
McLean County6
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : The incidence rate is 72.9 with a 95% confidence interval from 40.8 to 120.2 and 3 average annual cases over 2017-2021.
- CI*Rank ⋔ : 10 (2, 15)
- Percent of Cases with Late Stage : 47.1
Ward County6
- 2023 Rural-Urban Continuum Codes Φ : Urban
- Rate : The incidence rate is 71.0 with a 95% confidence interval from 55.4 to 89.7 and 15 average annual cases over 2017-2021.
- CI*Rank ⋔ : 11 (4, 14)
- Percent of Cases with Late Stage : 60.3
Stutsman County6
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : The incidence rate is 61.8 with a 95% confidence interval from 39.8 to 91.4 and 5 average annual cases over 2017-2021.
- CI*Rank ⋔ : 12 (4, 15)
- Percent of Cases with Late Stage : 76.5
Burleigh County6
- 2023 Rural-Urban Continuum Codes Φ : Urban
- Rate : The incidence rate is 56.5 with a 95% confidence interval from 45.7 to 69.1 and 20 average annual cases over 2017-2021.
- CI*Rank ⋔ : 13 (8, 15)
- Percent of Cases with Late Stage : 55.0
Stark County6
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : The incidence rate is 49.3 with a 95% confidence interval from 30.8 to 74.6 and 5 average annual cases over 2017-2021.
- CI*Rank ⋔ : 14 (7, 15)
- Percent of Cases with Late Stage : 51.1
Morton County6
- 2023 Rural-Urban Continuum Codes Φ : Urban
- Rate : The incidence rate is 48.7 with a 95% confidence interval from 31.9 to 71.0 and 6 average annual cases over 2017-2021.
- CI*Rank ⋔ : 15 (9, 15)
- Percent of Cases with Late Stage : 47.5
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Urban
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Urban
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Urban
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
- 2023 Rural-Urban Continuum Codes Φ : Rural
- Rate : * 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).
- CI*Rank ⋔ : *
- Percent of Cases with Late Stage : *
Notes:
Created by statecancerprofiles.cancer.gov on 12/14/2024 5:35 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.
† 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.
⋔ 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.
Φ Rural-Urban Continuum Codes provided by the USDA.
* 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 - United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Based on the 2023 submission.
6 Source: National Program of Cancer Registries SEER*Stat Database - United States Department of Health and Human Services, Centers for Disease Control and Prevention (based on the 2023 submission).
Data for the United States does not include data from Indiana.
Data for the United States does not include Puerto Rico.