Data Table for Rate/Trend Comparison by Cancer
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 | - | 283,896 | 128.7 (128.5, 129.0) | - | -1.9 (-2.2, -1.7) |
Virginia | - | falling | - | 7,161 | 127.9 (126.6, 129.3) | - | -1.6 (-1.7, -1.5) |
Greensville County | 1 | rising | higher | 14 | 217.1 (166.6, 280.0) | 1.7 | 1.6 (0.4, 2.8) |
Washington County | 2 | rising | similar | 67 | 142.1 (126.4, 159.6) | 1.1 | 7.6 (1.6, 13.9) |
Bath County | 4 | stable | higher | 8 | 194.1 (136.4, 276.9) | 1.5 | 0.4 (-0.9, 1.8) |
Buchanan County | 4 | stable | higher | 32 | 178.0 (150.0, 210.7) | 1.4 | -0.6 (-1.4, 0.3) |
Colonial Heights City | 4 | stable | higher | 25 | 167.6 (138.2, 202.2) | 1.3 | -0.6 (-1.3, 0.1) |
Dickenson County | 4 | stable | higher | 21 | 176.5 (142.5, 217.4) | 1.4 | 0.4 (-0.6, 1.4) |
Galax City | 4 | stable | higher | 17 | 324.5 (256.0, 407.9) | 2.5 | -14.0 (-36.5, 16.4) |
Grayson County | 4 | stable | higher | 24 | 161.1 (132.6, 196.0) | 1.3 | 0.0 (-1.1, 1.2) |
Halifax County with South Boston City | 4 | stable | higher | 50 | 163.8 (142.3, 188.0) | 1.3 | 0.1 (-0.5, 0.7) |
Hopewell City | 4 | stable | higher | 30 | 186.8 (157.3, 220.6) | 1.5 | 0.0 (-0.8, 0.9) |
Lee County | 4 | stable | higher | 32 | 160.2 (135.4, 189.1) | 1.2 | 0.6 (-0.3, 1.5) |
Martinsville City | 4 | stable | higher | 24 | 221.6 (182.5, 267.8) | 1.7 | 0.6 (-0.3, 1.6) |
Nottoway County | 4 | stable | higher | 19 | 165.5 (132.7, 205.2) | 1.3 | -0.1 (-1.1, 0.9) |
Patrick County | 4 | stable | higher | 28 | 156.8 (130.4, 188.7) | 1.2 | -0.1 (-1.1, 0.9) |
Russell County | 4 | stable | higher | 38 | 161.1 (137.9, 187.9) | 1.3 | -0.4 (-1.2, 0.3) |
Salem City | 4 | stable | higher | 36 | 178.9 (152.9, 208.8) | 1.4 | -0.2 (-1.1, 0.6) |
Scott County | 4 | stable | higher | 34 | 175.5 (148.6, 206.9) | 1.4 | 0.0 (-0.7, 0.7) |
Smyth County | 4 | stable | higher | 43 | 162.4 (140.6, 187.2) | 1.3 | -0.4 (-1.0, 0.3) |
Staunton City | 4 | stable | higher | 34 | 155.4 (132.1, 182.3) | 1.2 | -0.3 (-1.2, 0.6) |
Sussex County | 4 | stable | higher | 15 | 198.7 (154.9, 253.5) | 1.5 | -0.1 (-1.3, 1.1) |
Tazewell County | 4 | stable | higher | 58 | 160.0 (141.2, 181.1) | 1.2 | -0.3 (-0.9, 0.2) |
Waynesboro City | 4 | stable | higher | 31 | 177.5 (149.8, 209.4) | 1.4 | 0.0 (-0.7, 0.8) |
Wise County | 4 | stable | higher | 47 | 173.1 (151.0, 197.9) | 1.3 | -0.4 (-0.9, 0.2) |
Wythe County | 4 | stable | higher | 38 | 154.2 (132.2, 179.4) | 1.2 | -0.5 (-1.1, 0.1) |
Accomack County | 5 | falling | higher | 50 | 176.0 (153.1, 201.9) | 1.4 | -0.6 (-1.1, -0.1) |
Caroline County | 5 | falling | higher | 33 | 155.1 (131.7, 181.7) | 1.2 | -0.7 (-1.4, -0.1) |
Fairfax City | 5 | falling | higher | 27 | 172.8 (144.0, 206.2) | 1.3 | -1.4 (-2.4, -0.4) |
Franklin City | 5 | falling | higher | 12 | 179.2 (133.8, 236.7) | 1.4 | -1.4 (-2.5, -0.3) |
Gloucester County | 5 | falling | higher | 47 | 162.4 (141.7, 185.8) | 1.3 | -0.9 (-1.6, -0.1) |
Lynchburg City | 5 | falling | higher | 75 | 148.2 (132.8, 165.0) | 1.2 | -0.8 (-1.2, -0.4) |
Newport News City | 5 | falling | higher | 167 | 153.1 (142.7, 164.0) | 1.2 | -0.8 (-1.2, -0.4) |
Norfolk City | 5 | falling | higher | 195 | 153.3 (143.6, 163.6) | 1.2 | -1.4 (-1.7, -1.1) |
Petersburg City | 5 | falling | higher | 48 | 208.5 (181.3, 238.9) | 1.6 | -0.9 (-1.7, -0.1) |
Portsmouth City | 5 | falling | higher | 109 | 172.5 (158.0, 188.1) | 1.3 | -0.7 (-1.1, -0.2) |
Roanoke City | 5 | falling | higher | 120 | 165.2 (151.7, 179.6) | 1.3 | -0.5 (-0.8, -0.1) |
Suffolk City | 5 | falling | higher | 83 | 144.1 (130.3, 158.9) | 1.1 | -1.5 (-2.1, -1.0) |
Amelia County | 6 | stable | similar | 17 | 161.0 (126.7, 203.2) | 1.3 | 0.0 (-1.2, 1.1) |
Appomattox County | 6 | stable | similar | 16 | 130.4 (102.6, 164.4) | 1.0 | -0.1 (-1.3, 1.2) |
Bland County | 6 | stable | similar | 6 | 114.2 (77.6, 168.9) | 0.9 | -1.0 (-2.7, 0.8) |
Bristol City | 6 | stable | similar | 23 | 148.6 (121.5, 181.2) | 1.2 | -17.2 (-32.5, 1.7) |
Buckingham County | 6 | stable | similar | 14 | 107.6 (83.0, 138.7) | 0.8 | -1.2 (-2.4, 0.0) |
Buena Vista City | 6 | stable | similar | 9 | 162.4 (116.3, 223.3) | 1.3 | -1.2 (-2.6, 0.2) |
Carroll County | 6 | stable | similar | 37 | 131.4 (112.1, 153.8) | 1.0 | -0.4 (-1.1, 0.3) |
Charles City County | 6 | stable | similar | 10 | 144.7 (105.6, 198.9) | 1.1 | -1.3 (-2.7, 0.1) |
Charlotte County | 6 | stable | similar | 15 | 143.1 (111.5, 182.9) | 1.1 | -0.9 (-1.9, 0.0) |
Covington City | 6 | stable | similar | 9 | 186.0 (131.6, 258.1) | 1.4 | 1.0 (-0.7, 2.6) |
Cumberland County | 6 | stable | similar | 12 | 146.0 (109.2, 193.0) | 1.1 | -0.3 (-1.7, 1.2) |
Dinwiddie County | 6 | stable | similar | 28 | 134.1 (112.3, 159.3) | 1.0 | -0.6 (-1.6, 0.3) |
Emporia City | 6 | stable | similar | 6 | 146.7 (98.9, 212.4) | 1.1 | -1.4 (-2.8, 0.1) |
Essex County | 6 | stable | similar | 14 | 143.3 (109.6, 186.1) | 1.1 | -0.9 (-1.9, 0.2) |
Floyd County | 6 | stable | similar | 16 | 123.3 (95.8, 157.5) | 1.0 | -0.3 (-1.6, 1.0) |
Henry County | 6 | stable | similar | 66 | 141.0 (125.0, 158.8) | 1.1 | 0.4 (-0.2, 1.1) |
King and Queen County | 6 | stable | similar | 9 | 149.6 (107.2, 207.5) | 1.2 | 0.0 (-1.4, 1.4) |
Lexington City | 6 | stable | similar | 8 | 162.4 (113.1, 233.1) | 1.3 | -1.7 (-3.6, 0.3) |
Louisa County | 6 | stable | similar | 39 | 143.9 (123.9, 166.5) | 1.1 | -0.6 (-1.5, 0.4) |
Lunenburg County | 6 | stable | similar | 14 | 138.2 (105.7, 179.4) | 1.1 | -0.6 (-1.5, 0.3) |
Madison County | 6 | stable | similar | 14 | 134.3 (102.7, 173.8) | 1.0 | -0.9 (-1.9, 0.2) |
Middlesex County | 6 | stable | similar | 16 | 131.6 (102.5, 170.4) | 1.0 | -0.3 (-1.5, 0.9) |
Nelson County | 6 | stable | similar | 18 | 124.2 (98.8, 156.2) | 1.0 | -0.9 (-2.1, 0.4) |
Norton City | 6 | stable | similar | 5 | 153.5 (99.1, 232.2) | 1.2 | -0.6 (-2.1, 1.0) |
Page County | 6 | stable | similar | 30 | 148.4 (124.8, 176.0) | 1.2 | -0.1 (-1.1, 0.9) |
Pittsylvania County | 6 | stable | similar | 65 | 122.6 (109.0, 137.8) | 1.0 | -0.5 (-1.1, 0.0) |
Radford City | 6 | stable | similar | 10 | 134.4 (99.7, 177.8) | 1.0 | -0.9 (-2.3, 0.4) |
Richmond County | 6 | stable | similar | 14 | 160.9 (123.8, 210.2) | 1.2 | -0.6 (-1.8, 0.7) |
Rockingham County | 6 | stable | similar | 76 | 118.1 (106.2, 131.1) | 0.9 | -0.6 (-1.3, 0.0) |
Southampton County | 6 | stable | similar | 17 | 121.7 (96.2, 153.1) | 0.9 | -0.8 (-1.8, 0.3) |
Surry County | 6 | stable | similar | 8 | 141.2 (98.2, 200.9) | 1.1 | -0.6 (-2.2, 1.0) |
Augusta County | 7 | stable | lower | 70 | 111.3 (99.6, 124.1) | 0.9 | 3.4 (-8.3, 16.7) |
Botetourt County | 7 | stable | lower | 32 | 110.7 (94.0, 130.4) | 0.9 | -0.5 (-1.2, 0.1) |
Alleghany County and Clifton Forge City | 8 | falling | similar | 17 | 122.9 (96.6, 155.9) | 1.0 | -1.3 (-2.3, -0.3) |
Amherst County | 8 | falling | similar | 35 | 132.6 (112.9, 155.3) | 1.0 | -1.4 (-2.0, -0.8) |
Bedford City and County | 8 | falling | similar | 84 | 126.1 (114.0, 139.4) | 1.0 | -0.6 (-1.1, -0.1) |
Brunswick County | 8 | falling | similar | 21 | 155.2 (124.4, 192.7) | 1.2 | -1.2 (-2.4, 0.0) |
Campbell County | 8 | falling | similar | 63 | 139.5 (124.0, 156.6) | 1.1 | -0.7 (-1.3, -0.2) |
Charlottesville City | 8 | falling | similar | 29 | 124.5 (104.7, 147.0) | 1.0 | -1.6 (-2.2, -1.0) |
Chesapeake City | 8 | falling | similar | 203 | 140.7 (132.1, 149.9) | 1.1 | -1.3 (-1.6, -0.9) |
Chesterfield County | 8 | falling | similar | 283 | 130.0 (123.1, 137.1) | 1.0 | -1.2 (-1.5, -0.9) |
Clarke County | 8 | falling | similar | 14 | 113.7 (87.8, 146.6) | 0.9 | -1.7 (-2.7, -0.7) |
Culpeper County | 8 | falling | similar | 46 | 137.9 (120.3, 157.5) | 1.1 | -1.3 (-2.0, -0.6) |
Danville City | 8 | falling | similar | 54 | 143.6 (126.0, 163.4) | 1.1 | -0.8 (-1.3, -0.2) |
Falls Church City | 8 | falling | similar | 9 | 107.6 (78.7, 144.4) | 0.8 | -2.6 (-3.8, -1.5) |
Fauquier County | 8 | falling | similar | 61 | 126.7 (112.6, 142.1) | 1.0 | -1.6 (-2.4, -0.9) |
Fluvanna County | 8 | falling | similar | 29 | 135.2 (113.9, 160.0) | 1.1 | -1.1 (-1.9, -0.3) |
Franklin County | 8 | falling | similar | 60 | 125.4 (110.8, 141.7) | 1.0 | -0.9 (-1.6, -0.2) |
Frederick County | 8 | falling | similar | 87 | 141.5 (128.3, 156.0) | 1.1 | -1.1 (-1.6, -0.5) |
Fredericksburg City | 8 | falling | similar | 16 | 111.7 (88.5, 139.1) | 0.9 | -2.3 (-3.3, -1.3) |
Giles County | 8 | falling | similar | 22 | 153.4 (125.3, 187.2) | 1.2 | -1.0 (-1.9, -0.2) |
Goochland County | 8 | falling | similar | 22 | 116.1 (94.4, 142.3) | 0.9 | -1.7 (-2.9, -0.5) |
Greene County | 8 | falling | similar | 15 | 108.1 (84.4, 137.1) | 0.8 | -2.1 (-3.2, -1.0) |
Hampton City | 8 | falling | similar | 127 | 139.8 (128.9, 151.5) | 1.1 | -1.2 (-1.6, -0.9) |
Hanover County | 8 | falling | similar | 109 | 138.7 (127.0, 151.3) | 1.1 | -1.1 (-1.5, -0.6) |
Harrisonburg City | 8 | falling | similar | 26 | 112.7 (93.5, 134.6) | 0.9 | -1.2 (-2.2, -0.3) |
Henrico County | 8 | falling | similar | 310 | 134.5 (127.7, 141.6) | 1.0 | -1.0 (-1.2, -0.8) |
Isle of Wight County | 8 | falling | similar | 36 | 122.7 (104.9, 143.2) | 1.0 | -1.0 (-1.8, -0.1) |
James City County | 8 | falling | similar | 85 | 117.8 (106.1, 130.7) | 0.9 | -1.4 (-2.1, -0.8) |
King George County | 8 | falling | similar | 16 | 109.5 (86.5, 137.0) | 0.9 | -5.2 (-7.9, -2.4) |
King William County | 8 | falling | similar | 14 | 122.4 (95.0, 155.9) | 1.0 | -1.6 (-2.7, -0.5) |
Lancaster County | 8 | falling | similar | 21 | 149.0 (116.1, 192.2) | 1.2 | -1.8 (-2.6, -1.0) |
Manassas City | 8 | falling | similar | 28 | 151.0 (126.2, 179.1) | 1.2 | -1.2 (-2.4, 0.0) |
Mathews County | 8 | falling | similar | 12 | 121.5 (91.6, 163.2) | 0.9 | -2.1 (-3.2, -1.1) |
Mecklenburg County | 8 | falling | similar | 45 | 145.6 (126.0, 168.2) | 1.1 | -1.0 (-1.5, -0.4) |
New Kent County | 8 | falling | similar | 20 | 143.3 (115.6, 176.1) | 1.1 | -1.3 (-2.2, -0.4) |
Northampton County | 8 | falling | similar | 14 | 114.1 (86.8, 150.0) | 0.9 | -5.4 (-7.5, -3.3) |
Northumberland County | 8 | falling | similar | 19 | 114.5 (91.8, 145.8) | 0.9 | -1.6 (-2.4, -0.8) |
Orange County | 8 | falling | similar | 40 | 132.6 (114.2, 153.5) | 1.0 | -1.1 (-1.9, -0.3) |
Poquoson City | 8 | falling | similar | 13 | 143.0 (110.2, 184.2) | 1.1 | -2.3 (-3.8, -0.7) |
Powhatan County | 8 | falling | similar | 23 | 114.9 (94.3, 139.4) | 0.9 | -15.4 (-27.7, -1.0) |
Prince Edward County | 8 | falling | similar | 24 | 155.3 (127.0, 188.6) | 1.2 | -0.9 (-1.7, 0.0) |
Prince George County | 8 | falling | similar | 26 | 121.0 (100.7, 144.4) | 0.9 | -1.7 (-2.7, -0.7) |
Prince William County | 8 | falling | similar | 245 | 116.1 (109.5, 123.1) | 0.9 | -2.1 (-2.4, -1.8) |
Pulaski County | 8 | falling | similar | 36 | 118.3 (101.0, 138.5) | 0.9 | -2.2 (-3.3, -1.0) |
Richmond City | 8 | falling | similar | 175 | 127.0 (118.4, 136.1) | 1.0 | -3.0 (-3.7, -2.2) |
Rockbridge County | 8 | falling | similar | 26 | 110.9 (91.8, 134.0) | 0.9 | -1.6 (-2.3, -1.0) |
Shenandoah County | 8 | falling | similar | 52 | 141.0 (123.8, 160.3) | 1.1 | -0.8 (-1.2, -0.3) |
Spotsylvania County | 8 | falling | similar | 106 | 130.3 (119.3, 142.2) | 1.0 | -1.8 (-2.4, -1.2) |
Stafford County | 8 | falling | similar | 89 | 126.5 (114.7, 139.2) | 1.0 | -1.4 (-2.0, -0.8) |
Virginia Beach City | 8 | falling | similar | 363 | 128.7 (122.8, 134.9) | 1.0 | -1.3 (-1.6, -1.0) |
Warren County | 8 | falling | similar | 38 | 141.4 (121.6, 163.7) | 1.1 | -0.9 (-1.8, -0.1) |
Westmoreland County | 8 | falling | similar | 24 | 140.9 (115.3, 171.9) | 1.1 | -1.0 (-1.7, -0.4) |
Winchester City | 8 | falling | similar | 28 | 147.2 (123.2, 174.8) | 1.1 | -1.5 (-2.3, -0.8) |
Albemarle County | 9 | falling | lower | 88 | 102.2 (92.6, 112.7) | 0.8 | -1.5 (-2.0, -1.0) |
Alexandria City | 9 | falling | lower | 82 | 99.3 (89.7, 109.7) | 0.8 | -2.8 (-3.2, -2.3) |
Arlington County | 9 | falling | lower | 106 | 95.8 (87.6, 104.5) | 0.7 | -3.5 (-4.3, -2.6) |
Fairfax County | 9 | falling | lower | 634 | 95.8 (92.4, 99.2) | 0.7 | -2.2 (-2.4, -2.0) |
Loudoun County | 9 | falling | lower | 188 | 105.3 (98.6, 112.4) | 0.8 | -2.3 (-2.7, -1.8) |
Montgomery County | 9 | falling | lower | 55 | 103.1 (91.0, 116.5) | 0.8 | -1.9 (-2.5, -1.3) |
Rappahannock County | 9 | falling | lower | 7 | 89.3 (60.2, 132.9) | 0.7 | -1.6 (-2.8, -0.3) |
Roanoke County | 9 | falling | lower | 95 | 111.7 (101.4, 122.8) | 0.9 | -0.9 (-1.4, -0.4) |
Williamsburg City | 9 | falling | lower | 7 | 65.1 (44.0, 95.0) | 0.5 | -3.9 (-5.4, -2.4) |
York County | 9 | falling | lower | 50 | 107.3 (94.2, 121.8) | 0.8 | -2.2 (-3.0, -1.4) |
Craig County |
|
** | similar | 5 | 109.5 (71.7, 167.8) | 0.9 |
|
Manassas Park City |
|
** | lower | 4 | 66.2 (41.1, 100.2) | 0.5 |
|
Highland County |
|
** |
|
|
|
|
|
Notes:
Created by statecancerprofiles.cancer.gov on 04/25/2024 6:35 pm.
* Data has been suppressed to ensure confidentiality and stability of rate and trend estimates.
** Data are too sparse to provide stable estimates of annual rates needed to calculate trend.
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 Version 4.8.0.0. 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 (19 age groups: <1, 1-4, 5-9, ... , 80-84, 85+). The Healthy People 2020 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).
Data for the following has been suppressed to ensure confidentiality and stability of rate and trend estimates:
Highland County
Trend for the following could not be reliably determined due to small number of deaths per year:
Craig County, Manassas Park City
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 does not include Puerto Rico.
Created by statecancerprofiles.cancer.gov on 04/25/2024 6:35 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 > 1.10
Similar when unable to conclude above or below with confidence.
Below when 95% confident the rate is below and Rate Ratio3 < 0.90
* Data has been suppressed to ensure confidentiality and stability of rate and trend estimates.
** Data are too sparse to provide stable estimates of annual rates needed to calculate trend.
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 Version 4.8.0.0. 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 (19 age groups: <1, 1-4, 5-9, ... , 80-84, 85+). The Healthy People 2020 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).
Data for the following has been suppressed to ensure confidentiality and stability of rate and trend estimates:
Highland County
Trend for the following could not be reliably determined due to small number of deaths per year:
Craig County, Manassas Park City
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 does not include Puerto Rico.