Data Table for Rate/Trend Comparison by Cancer
Death Rate/Trend Comparison by Cancer, 2019-2023
Virginia Counties versus United States
All Cancer Sites
All Races, Both Sexes
Sorted by rate
Counties
|
Priority Index1 1=highest 9=lowest 
|
Recent Trend2 |
County Death Rate Compared to US Rate |
Average Annual Count
|
Age-Adjusted Death Rate deaths per 100,000 (95% Confidence Interval) 
|
Rate Ratio3 County to US
|
Recent 5-Year Trend2 in Death Rates (95% Confidence Interval)
|
|---|---|---|---|---|---|---|---|
| United States | - | falling | - | 605,771 | 145.4 (145.2, 145.6) | - | -1.3 (-1.5, -1.2) |
| Virginia | - | falling | - | 15,616 | 147.9 (146.9, 149.0) | - | -1.3 (-1.5, -0.7) |
| Galax City | 5 | falling | higher | 24 | 273.1 (224.8, 329.2) | 1.9 | -8.9 (-19.0, -3.4) |
| Franklin City | 1 | rising | higher | 29 | 251.3 (210.7, 298.2) | 1.7 | 14.1 (3.5, 20.6) |
| Fairfax City | 1 | rising | higher | 65 | 249.9 (223.0, 279.3) | 1.7 | 5.1 (1.3, 13.5) |
| Martinsville City | 1 | rising | higher | 42 | 244.3 (211.2, 281.3) | 1.7 | 1.4 (0.1, 2.8) |
| Norton City | 4 | stable | higher | 12 | 241.6 (183.1, 314.5) | 1.7 | -0.4 (-2.5, 1.8) |
| Petersburg City | 4 | stable | higher | 99 | 238.7 (217.4, 261.7) | 1.6 | 1.1 (-0.3, 6.6) |
| Greensville County | 4 | stable | higher | 30 | 229.1 (193.0, 270.5) | 1.6 | 0.2 (-1.7, 2.1) |
| Wise County | 4 | stable | higher | 110 | 226.4 (207.4, 246.9) | 1.6 | -0.5 (-1.1, 0.1) |
| Danville City | 1 | rising | higher | 138 | 221.3 (204.5, 239.3) | 1.5 | 7.5 (5.5, 10.3) |
| Hopewell City | 5 | falling | higher | 58 | 219.3 (194.3, 246.8) | 1.5 | -0.9 (-1.7, 0.0) |
| Sussex County | 4 | stable | higher | 31 | 207.1 (174.5, 244.7) | 1.4 | -0.7 (-1.7, 0.3) |
| Lee County | 4 | stable | higher | 73 | 206.1 (184.9, 229.5) | 1.4 | -0.6 (-1.6, 0.4) |
| Smyth County | 4 | stable | higher | 99 | 205.9 (187.6, 225.7) | 1.4 | -0.3 (-0.9, 0.2) |
| Colonial Heights City | 4 | stable | higher | 53 | 205.0 (180.5, 232.3) | 1.4 | 2.5 (-0.1, 11.0) |
| Nottoway County | 4 | stable | higher | 44 | 201.1 (175.1, 230.2) | 1.4 | -0.8 (-1.7, 0.1) |
| Buchanan County | 4 | stable | higher | 66 | 197.2 (175.8, 221.0) | 1.4 | 0.7 (-1.0, 6.7) |
| Waynesboro City | 4 | stable | higher | 60 | 197.0 (174.9, 221.2) | 1.4 | -0.4 (-1.4, 0.6) |
| Prince Edward County | 4 | stable | higher | 50 | 196.4 (171.9, 223.5) | 1.4 | 0.4 (-0.5, 3.9) |
| Covington City | 5 | falling | higher | 16 | 195.3 (153.7, 246.0) | 1.3 | -11.1 (-25.4, -5.1) |
| Dickenson County | 4 | stable | higher | 44 | 192.4 (166.8, 221.6) | 1.3 | -0.6 (-2.0, 0.8) |
| Patrick County | 4 | stable | higher | 62 | 190.5 (168.7, 215.0) | 1.3 | -0.3 (-1.3, 0.8) |
| Craig County | 4 | stable | higher | 16 | 189.8 (148.3, 241.9) | 1.3 | -0.2 (-2.3, 2.0) |
| Portsmouth City | 5 | falling | higher | 210 | 188.7 (177.1, 200.8) | 1.3 | -1.3 (-1.8, -0.8) |
| Roanoke City | 5 | falling | higher | 242 | 188.6 (177.8, 199.9) | 1.3 | -0.7 (-1.1, -0.3) |
| Russell County | 4 | stable | higher | 78 | 188.5 (169.4, 209.4) | 1.3 | -0.6 (-1.5, 0.2) |
| Halifax County with South Boston City | 4 | stable | higher | 111 | 187.6 (171.5, 205.0) | 1.3 | -0.5 (-1.3, 0.4) |
| King and Queen County | 4 | stable | higher | 21 | 187.0 (151.3, 230.3) | 1.3 | -1.2 (-2.6, 0.1) |
| Tazewell County | 4 | stable | higher | 120 | 186.8 (171.5, 203.2) | 1.3 | -0.2 (-1.0, 0.6) |
| Giles County | 4 | stable | higher | 50 | 186.5 (163.5, 212.4) | 1.3 | -1.0 (-2.0, 0.0) |
| Charlotte County | 4 | stable | higher | 34 | 186.2 (158.0, 218.7) | 1.3 | 0.1 (-1.1, 4.6) |
| Brunswick County | 4 | stable | higher | 47 | 185.7 (161.9, 212.6) | 1.3 | 0.6 (-2.0, 9.5) |
| Lynchburg City | 4 | stable | higher | 157 | 184.9 (171.9, 198.7) | 1.3 | 0.0 (-0.8, 3.1) |
| Cumberland County | 4 | stable | higher | 28 | 184.7 (153.7, 220.9) | 1.3 | -1.1 (-2.3, 0.1) |
| Orange County | 5 | falling | higher | 100 | 184.1 (167.9, 201.6) | 1.3 | -1.1 (-1.8, -0.3) |
| Bristol City | 4 | stable | higher | 50 | 183.7 (161.0, 209.2) | 1.3 | -0.8 (-2.4, 0.6) |
| New Kent County | 4 | stable | higher | 56 | 183.7 (161.3, 208.5) | 1.3 | -0.9 (-2.1, 0.6) |
| Scott County | 4 | stable | higher | 69 | 183.4 (163.8, 205.2) | 1.3 | -0.7 (-1.9, 0.4) |
| Salem City | 4 | stable | higher | 66 | 183.2 (163.4, 204.9) | 1.3 | -0.6 (-1.7, 0.4) |
| Bath County | 6 | stable | similar | 15 | 182.7 (141.6, 235.8) | 1.3 | -0.8 (-3.1, 1.5) |
| Staunton City | 4 | stable | higher | 70 | 182.4 (163.4, 203.3) | 1.3 | -0.3 (-1.3, 0.8) |
| Lancaster County | 5 | falling | higher | 48 | 180.8 (154.1, 212.3) | 1.2 | -1.2 (-2.4, 0.0) |
| Buckingham County | 5 | falling | higher | 46 | 180.6 (157.5, 206.6) | 1.2 | -1.6 (-2.8, -0.4) |
| Norfolk City | 5 | falling | higher | 408 | 179.8 (171.8, 188.1) | 1.2 | -1.4 (-1.8, -1.0) |
| Warren County | 4 | stable | higher | 96 | 179.3 (163.1, 196.8) | 1.2 | -0.7 (-1.4, 0.0) |
| Wythe County | 4 | stable | higher | 78 | 178.9 (161.0, 198.4) | 1.2 | -0.7 (-1.6, 0.1) |
| Dinwiddie County | 5 | falling | higher | 70 | 178.5 (159.7, 199.2) | 1.2 | -1.8 (-2.6, -1.0) |
| Emporia City | 8 | falling | similar | 14 | 177.1 (136.0, 227.5) | 1.2 | -2.0 (-3.9, -0.3) |
| Shenandoah County | 4 | stable | higher | 122 | 177.1 (162.8, 192.3) | 1.2 | -0.5 (-1.2, 0.1) |
| Page County | 4 | stable | higher | 68 | 176.5 (157.8, 197.3) | 1.2 | -0.3 (-1.3, 0.8) |
| Lunenburg County | 5 | falling | higher | 35 | 175.5 (149.4, 205.5) | 1.2 | -1.3 (-2.5, 0.0) |
| Essex County | 6 | stable | similar | 29 | 174.9 (146.2, 208.4) | 1.2 | -1.1 (-2.6, 0.3) |
| Gloucester County | 5 | falling | higher | 101 | 174.6 (159.2, 191.3) | 1.2 | -1.2 (-2.2, -0.3) |
| Mecklenburg County | 5 | falling | higher | 98 | 174.6 (158.8, 191.9) | 1.2 | -0.9 (-1.6, -0.2) |
| Newport News City | 5 | falling | higher | 340 | 174.4 (166.0, 183.1) | 1.2 | -1.1 (-1.6, -0.7) |
| Amelia County | 5 | falling | higher | 36 | 172.7 (147.5, 201.7) | 1.2 | -1.6 (-2.7, -0.4) |
| Grayson County | 5 | falling | higher | 47 | 172.4 (150.3, 197.6) | 1.2 | -1.2 (-2.3, -0.2) |
| Radford City | 8 | falling | similar | 20 | 171.9 (139.2, 209.8) | 1.2 | -1.4 (-2.7, -0.1) |
| Richmond County | 6 | stable | similar | 25 | 171.7 (142.1, 206.5) | 1.2 | -0.6 (-1.8, 0.6) |
| Accomack County | 5 | falling | higher | 100 | 171.3 (155.9, 188.0) | 1.2 | -1.6 (-2.1, -1.0) |
| King William County | 5 | falling | higher | 39 | 170.6 (146.7, 197.4) | 1.2 | -2.0 (-3.1, -0.8) |
| Washington County | 4 | stable | higher | 152 | 170.6 (158.1, 183.9) | 1.2 | 1.7 (-1.2, 7.1) |
| Henry County | 4 | stable | higher | 147 | 170.4 (157.6, 184.1) | 1.2 | -0.6 (-1.4, 0.2) |
| Falls Church City | 6 | stable | similar | 28 | 169.6 (142.2, 201.0) | 1.2 | 11.8 (-2.6, 31.1) |
| Fredericksburg City | 5 | falling | higher | 42 | 169.5 (146.9, 194.6) | 1.2 | -2.4 (-3.5, -1.3) |
| Isle of Wight County | 5 | falling | higher | 95 | 168.6 (153.3, 185.2) | 1.2 | -1.7 (-2.6, -0.7) |
| Hampton City | 5 | falling | higher | 276 | 168.1 (159.1, 177.5) | 1.2 | -1.4 (-1.9, -0.8) |
| Nelson County | 6 | stable | similar | 47 | 166.3 (144.1, 191.6) | 1.1 | -0.8 (-1.9, 0.2) |
| Mathews County | 6 | stable | similar | 29 | 165.0 (135.7, 200.4) | 1.1 | -1.1 (-3.0, 0.7) |
| Surry County | 6 | stable | similar | 18 | 164.2 (129.6, 206.9) | 1.1 | -1.6 (-3.9, 0.7) |
| Buena Vista City | 8 | falling | similar | 15 | 164.2 (128.3, 207.9) | 1.1 | -1.6 (-3.3, -0.1) |
| Pittsylvania County | 5 | falling | higher | 165 | 163.8 (152.2, 176.1) | 1.1 | -1.1 (-1.7, -0.5) |
| Amherst County | 5 | falling | higher | 81 | 162.6 (146.8, 179.9) | 1.1 | -1.6 (-2.4, -0.9) |
| King George County | 8 | falling | similar | 48 | 161.7 (141.3, 184.2) | 1.1 | -1.7 (-2.8, -0.4) |
| Suffolk City | 5 | falling | higher | 181 | 161.4 (150.8, 172.5) | 1.1 | -2.1 (-2.6, -1.6) |
| Chesapeake City | 5 | falling | higher | 430 | 161.3 (154.4, 168.5) | 1.1 | -1.8 (-2.2, -1.5) |
| Southampton County | 8 | falling | similar | 47 | 161.1 (140.7, 184.2) | 1.1 | -1.5 (-2.4, -0.6) |
| Frederick County | 5 | falling | higher | 200 | 160.7 (150.7, 171.3) | 1.1 | -1.4 (-1.9, -0.8) |
| Poquoson City | 6 | stable | similar | 29 | 160.2 (134.9, 189.5) | 1.1 | -0.9 (-2.4, 0.8) |
| Caroline County | 8 | falling | similar | 64 | 159.4 (141.9, 178.5) | 1.1 | -2.0 (-2.7, -1.4) |
| Louisa County | 8 | falling | similar | 90 | 157.2 (142.3, 173.4) | 1.1 | -1.9 (-2.9, -1.0) |
| Winchester City | 8 | falling | similar | 55 | 157.0 (138.7, 177.1) | 1.1 | -1.9 (-2.8, -1.0) |
| Alleghany County and Clifton Forge City | 8 | falling | similar | 44 | 156.8 (135.8, 180.9) | 1.1 | -1.5 (-2.8, -0.3) |
| Culpeper County | 8 | falling | similar | 101 | 156.8 (143.1, 171.4) | 1.1 | -1.4 (-2.1, -0.7) |
| Bedford City and County | 8 | falling | similar | 200 | 156.5 (146.6, 167.0) | 1.1 | -0.9 (-1.5, -0.3) |
| Manassas City | 6 | stable | similar | 52 | 156.3 (136.6, 178.0) | 1.1 | 1.4 (-2.1, 10.0) |
| Middlesex County | 8 | falling | similar | 39 | 155.8 (133.2, 182.8) | 1.1 | -1.5 (-2.5, -0.4) |
| Carroll County | 8 | falling | similar | 84 | 155.6 (140.5, 172.3) | 1.1 | -1.1 (-2.2, -0.1) |
| Pulaski County | 8 | falling | similar | 85 | 155.2 (140.3, 171.4) | 1.1 | -1.8 (-2.4, -1.2) |
| Madison County | 6 | stable | similar | 34 | 155.1 (131.3, 182.6) | 1.1 | -1.1 (-2.4, 0.2) |
| Westmoreland County | 8 | falling | similar | 54 | 155.0 (136.3, 176.3) | 1.1 | -2.3 (-3.7, -1.0) |
| Bland County | 6 | stable | similar | 17 | 154.6 (122.5, 194.9) | 1.1 | -1.1 (-3.0, 0.8) |
| Floyd County | 6 | stable | similar | 40 | 153.7 (132.2, 178.4) | 1.1 | -0.3 (-1.5, 0.9) |
| Prince George County | 8 | falling | similar | 64 | 153.5 (136.8, 171.7) | 1.1 | -1.7 (-2.6, -0.6) |
| Hanover County | 8 | falling | similar | 237 | 153.0 (144.2, 162.2) | 1.1 | -1.4 (-2.0, -0.9) |
| Appomattox County | 6 | stable | similar | 37 | 152.7 (130.9, 177.5) | 1.1 | -1.3 (-2.9, 0.3) |
| Campbell County | 8 | falling | similar | 130 | 152.1 (140.3, 164.8) | 1.0 | -1.6 (-2.4, -0.8) |
| Franklin County | 8 | falling | similar | 135 | 151.3 (139.4, 164.1) | 1.0 | -0.6 (-1.1, -0.1) |
| Charles City County | 8 | falling | similar | 19 | 151.0 (120.4, 189.4) | 1.0 | -2.2 (-4.0, -0.4) |
| Fauquier County | 8 | falling | similar | 143 | 151.0 (139.9, 162.8) | 1.0 | -1.2 (-2.0, -0.4) |
| Botetourt County | 6 | stable | similar | 86 | 150.9 (136.5, 166.7) | 1.0 | 6.4 (-1.4, 12.3) |
| Williamsburg City | 8 | falling | similar | 27 | 150.6 (125.7, 179.8) | 1.0 | -23.0 (-40.1, -10.5) |
| Clarke County | 8 | falling | similar | 38 | 149.9 (129.0, 174.0) | 1.0 | -1.7 (-3.1, -0.4) |
| Henrico County | 8 | falling | similar | 622 | 148.6 (143.3, 154.0) | 1.0 | -1.3 (-1.7, -1.0) |
| Richmond City | 8 | falling | similar | 353 | 148.3 (141.2, 155.6) | 1.0 | -2.8 (-3.2, -2.5) |
| Virginia Beach City | 8 | falling | similar | 771 | 146.5 (141.9, 151.3) | 1.0 | -1.5 (-1.8, -1.3) |
| Stafford County | 8 | falling | similar | 203 | 146.1 (136.8, 155.8) | 1.0 | -2.0 (-2.3, -1.5) |
| Northumberland County | 8 | falling | similar | 44 | 145.6 (125.8, 169.4) | 1.0 | -1.7 (-2.9, -0.6) |
| Northampton County | 8 | falling | similar | 35 | 145.1 (123.0, 171.1) | 1.0 | -12.3 (-20.6, -2.8) |
| Rockingham County | 6 | stable | similar | 181 | 144.9 (135.4, 154.9) | 1.0 | 2.9 (-1.6, 6.2) |
| Chesterfield County | 8 | falling | similar | 609 | 144.8 (139.6, 150.2) | 1.0 | -1.7 (-1.9, -1.4) |
| Lexington City | 8 | falling | similar | 11 | 144.7 (108.8, 190.2) | 1.0 | -16.3 (-37.5, -4.2) |
| Spotsylvania County | 8 | falling | similar | 232 | 144.5 (136.1, 153.4) | 1.0 | -1.8 (-2.4, -1.1) |
| Rockbridge County | 8 | falling | similar | 60 | 143.7 (127.0, 162.5) | 1.0 | -1.6 (-2.5, -0.6) |
| Augusta County | 6 | stable | similar | 178 | 142.8 (133.4, 152.8) | 1.0 | 3.2 (-1.1, 6.3) |
| Charlottesville City | 8 | falling | similar | 62 | 142.2 (126.3, 159.5) | 1.0 | -1.9 (-2.6, -1.1) |
| Harrisonburg City | 6 | stable | similar | 57 | 141.7 (125.5, 159.5) | 1.0 | -1.1 (-2.4, 0.3) |
| Montgomery County | 8 | falling | similar | 137 | 139.7 (129.3, 150.8) | 1.0 | -1.3 (-1.9, -0.6) |
| Fluvanna County | 8 | falling | similar | 57 | 139.3 (123.2, 157.3) | 1.0 | -1.3 (-2.2, -0.3) |
| Roanoke County | 8 | falling | similar | 208 | 136.9 (128.5, 145.8) | 0.9 | -1.1 (-1.6, -0.5) |
| Goochland County | 8 | falling | similar | 56 | 132.5 (116.7, 150.2) | 0.9 | -2.2 (-3.2, -1.0) |
| Powhatan County | 8 | falling | similar | 58 | 131.0 (115.6, 148.1) | 0.9 | -2.8 (-3.5, -2.0) |
| Greene County | 8 | falling | similar | 36 | 129.6 (111.0, 150.8) | 0.9 | -1.6 (-2.8, -0.2) |
| Prince William County | 9 | falling | lower | 529 | 127.4 (122.4, 132.6) | 0.9 | -2.1 (-2.4, -1.8) |
| Highland County | 6 | stable | similar | 7 | 126.6 (87.4, 192.3) | 0.9 | -1.1 (-3.8, 1.6) |
| James City County | 9 | falling | lower | 186 | 124.4 (116.2, 133.1) | 0.9 | -1.2 (-2.0, -0.4) |
| York County | 9 | falling | lower | 113 | 124.2 (114.1, 135.1) | 0.9 | -2.7 (-3.4, -1.9) |
| Rappahannock County | 6 | stable | similar | 17 | 120.1 (94.7, 152.3) | 0.8 | -1.5 (-3.0, 0.2) |
| Alexandria City | 9 | falling | lower | 176 | 116.9 (109.2, 125.1) | 0.8 | -2.5 (-3.0, -1.9) |
| Albemarle County | 9 | falling | lower | 194 | 116.0 (108.7, 123.8) | 0.8 | -1.9 (-2.4, -1.4) |
| Loudoun County | 9 | falling | lower | 406 | 110.9 (106.0, 115.9) | 0.8 | -2.5 (-3.0, -1.9) |
| Arlington County | 9 | falling | lower | 226 | 106.5 (100.2, 113.0) | 0.7 | -2.3 (-2.7, -2.0) |
| Fairfax County | 9 | falling | lower | 1,311 | 103.3 (100.7, 105.8) | 0.7 | -2.2 (-2.4, -2.1) |
| Manassas Park City | 9 | falling | lower | 10 | 76.2 (55.4, 101.8) | 0.5 | -5.1 (-7.6, -2.7) |
Notes:
Created by statecancerprofiles.cancer.gov on 03/19/2026 6:18 pm.
1 Priority indices were created by ordering from rates that are rising and above the comparison rate to rates that are falling and below the comparison rate.
2 Recent trend in death rates is usually an Average Annual Percent Change (AAPC) based on the APCs calculated by Joinpoint. Due to data availability issues, the time period and/or calculation method used in the calculation of the trends may differ for selected geographic areas.
3 Rate ratio is the county rate divided by the US rate. Previous versions of this table used one-year rates for states and five-year rates for counties. As of June 2018, only five-year rates are used.
Source: Death data provided by the National Vital Statistics System public use data file. Death rates calculated by the National Cancer Institute using SEER*Stat. Death rates are age-adjusted to the 2000 US standard population (20 age groups: <1, 1-4, 5-9, ... , 80-84, 85-89, 90+). The Healthy People 2030 goals are based on rates adjusted using different methods but the differences should be minimal. Population counts for denominators are based on Census populations as modified by NCI. The US Population Data File is used with mortality data.
Note: 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. Suppression is used to avoid misinterpretation when rates are unstable.
State Cancer Registries may provide more current or more local data. Data presented on the State Cancer Profiles Web Site may differ from statistics reported by the State Cancer Registries (for more information).
Interpret Rankings provides insight into interpreting cancer 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 do not include Puerto Rico.
Created by statecancerprofiles.cancer.gov on 03/19/2026 6:18 pm.
Trend2
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.
Rate Comparison
Above when 95% confident the rate is above and Rate Ratio3 > 1.10
Similar
when unable to conclude above or below with confidence.
Below when 95% confident the rate is below and Rate Ratio3 < 0.90
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.Rate Comparison
Above
when 95% confident the rate is above and Rate Ratio3 > 1.10Similar
when unable to conclude above or below with confidence.Below
when 95% confident the rate is below and Rate Ratio3 < 0.901 Priority indices were created by ordering from rates that are rising and above the comparison rate to rates that are falling and below the comparison rate.
2 Recent trend in death rates is usually an Average Annual Percent Change (AAPC) based on the APCs calculated by Joinpoint. Due to data availability issues, the time period and/or calculation method used in the calculation of the trends may differ for selected geographic areas.
3 Rate ratio is the county rate divided by the US rate. Previous versions of this table used one-year rates for states and five-year rates for counties. As of June 2018, only five-year rates are used.
Source: Death data provided by the National Vital Statistics System public use data file. Death rates calculated by the National Cancer Institute using SEER*Stat. Death rates are age-adjusted to the 2000 US standard population (20 age groups: <1, 1-4, 5-9, ... , 80-84, 85-89, 90+). The Healthy People 2030 goals are based on rates adjusted using different methods but the differences should be minimal. Population counts for denominators are based on Census populations as modified by NCI. The US Population Data File is used with mortality data.
Note: 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. Suppression is used to avoid misinterpretation when rates are unstable.
State Cancer Registries may provide more current or more local data. Data presented on the State Cancer Profiles Web Site may differ from statistics reported by the State Cancer Registries (for more information).
Interpret Rankings provides insight into interpreting cancer 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 do not include Puerto Rico.