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) |
Norton City | 6 | stable | similar | 5 | 153.5 (99.1, 232.2) | 1.2 | -0.6 (-2.1, 1.0) |
Bland County | 6 | stable | similar | 6 | 114.2 (77.6, 168.9) | 0.9 | -1.0 (-2.7, 0.8) |
Emporia City | 6 | stable | similar | 6 | 146.7 (98.9, 212.4) | 1.1 | -1.4 (-2.8, 0.1) |
Rappahannock County | 9 | falling | lower | 7 | 89.3 (60.2, 132.9) | 0.7 | -1.6 (-2.8, -0.3) |
Williamsburg City | 9 | falling | lower | 7 | 65.1 (44.0, 95.0) | 0.5 | -3.9 (-5.4, -2.4) |
Bath County | 4 | stable | higher | 8 | 194.1 (136.4, 276.9) | 1.5 | 0.4 (-0.9, 1.8) |
Lexington City | 6 | stable | similar | 8 | 162.4 (113.1, 233.1) | 1.3 | -1.7 (-3.6, 0.3) |
Surry County | 6 | stable | similar | 8 | 141.2 (98.2, 200.9) | 1.1 | -0.6 (-2.2, 1.0) |
Buena Vista City | 6 | stable | similar | 9 | 162.4 (116.3, 223.3) | 1.3 | -1.2 (-2.6, 0.2) |
Covington City | 6 | stable | similar | 9 | 186.0 (131.6, 258.1) | 1.4 | 1.0 (-0.7, 2.6) |
King and Queen County | 6 | stable | similar | 9 | 149.6 (107.2, 207.5) | 1.2 | 0.0 (-1.4, 1.4) |
Falls Church City | 8 | falling | similar | 9 | 107.6 (78.7, 144.4) | 0.8 | -2.6 (-3.8, -1.5) |
Charles City County | 6 | stable | similar | 10 | 144.7 (105.6, 198.9) | 1.1 | -1.3 (-2.7, 0.1) |
Radford City | 6 | stable | similar | 10 | 134.4 (99.7, 177.8) | 1.0 | -0.9 (-2.3, 0.4) |
Cumberland County | 6 | stable | similar | 12 | 146.0 (109.2, 193.0) | 1.1 | -0.3 (-1.7, 1.2) |
Franklin City | 5 | falling | higher | 12 | 179.2 (133.8, 236.7) | 1.4 | -1.4 (-2.5, -0.3) |
Mathews County | 8 | falling | similar | 12 | 121.5 (91.6, 163.2) | 0.9 | -2.1 (-3.2, -1.1) |
Poquoson City | 8 | falling | similar | 13 | 143.0 (110.2, 184.2) | 1.1 | -2.3 (-3.8, -0.7) |
Clarke County | 8 | falling | similar | 14 | 113.7 (87.8, 146.6) | 0.9 | -1.7 (-2.7, -0.7) |
Essex County | 6 | stable | similar | 14 | 143.3 (109.6, 186.1) | 1.1 | -0.9 (-1.9, 0.2) |
Greensville County | 1 | rising | higher | 14 | 217.1 (166.6, 280.0) | 1.7 | 1.6 (0.4, 2.8) |
Richmond County | 6 | stable | similar | 14 | 160.9 (123.8, 210.2) | 1.2 | -0.6 (-1.8, 0.7) |
Buckingham County | 6 | stable | similar | 14 | 107.6 (83.0, 138.7) | 0.8 | -1.2 (-2.4, 0.0) |
King William County | 8 | falling | similar | 14 | 122.4 (95.0, 155.9) | 1.0 | -1.6 (-2.7, -0.5) |
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) |
Northampton County | 8 | falling | similar | 14 | 114.1 (86.8, 150.0) | 0.9 | -5.4 (-7.5, -3.3) |
Greene County | 8 | falling | similar | 15 | 108.1 (84.4, 137.1) | 0.8 | -2.1 (-3.2, -1.0) |
Charlotte County | 6 | stable | similar | 15 | 143.1 (111.5, 182.9) | 1.1 | -0.9 (-1.9, 0.0) |
Sussex County | 4 | stable | higher | 15 | 198.7 (154.9, 253.5) | 1.5 | -0.1 (-1.3, 1.1) |
Floyd County | 6 | stable | similar | 16 | 123.3 (95.8, 157.5) | 1.0 | -0.3 (-1.6, 1.0) |
King George County | 8 | falling | similar | 16 | 109.5 (86.5, 137.0) | 0.9 | -5.2 (-7.9, -2.4) |
Appomattox County | 6 | stable | similar | 16 | 130.4 (102.6, 164.4) | 1.0 | -0.1 (-1.3, 1.2) |
Fredericksburg City | 8 | falling | similar | 16 | 111.7 (88.5, 139.1) | 0.9 | -2.3 (-3.3, -1.3) |
Middlesex County | 6 | stable | similar | 16 | 131.6 (102.5, 170.4) | 1.0 | -0.3 (-1.5, 0.9) |
Amelia County | 6 | stable | similar | 17 | 161.0 (126.7, 203.2) | 1.3 | 0.0 (-1.2, 1.1) |
Southampton County | 6 | stable | similar | 17 | 121.7 (96.2, 153.1) | 0.9 | -0.8 (-1.8, 0.3) |
Alleghany County and Clifton Forge City | 8 | falling | similar | 17 | 122.9 (96.6, 155.9) | 1.0 | -1.3 (-2.3, -0.3) |
Galax City | 4 | stable | higher | 17 | 324.5 (256.0, 407.9) | 2.5 | -14.0 (-36.5, 16.4) |
Nelson County | 6 | stable | similar | 18 | 124.2 (98.8, 156.2) | 1.0 | -0.9 (-2.1, 0.4) |
Northumberland County | 8 | falling | similar | 19 | 114.5 (91.8, 145.8) | 0.9 | -1.6 (-2.4, -0.8) |
Nottoway County | 4 | stable | higher | 19 | 165.5 (132.7, 205.2) | 1.3 | -0.1 (-1.1, 0.9) |
New Kent County | 8 | falling | similar | 20 | 143.3 (115.6, 176.1) | 1.1 | -1.3 (-2.2, -0.4) |
Brunswick County | 8 | falling | similar | 21 | 155.2 (124.4, 192.7) | 1.2 | -1.2 (-2.4, 0.0) |
Dickenson County | 4 | stable | higher | 21 | 176.5 (142.5, 217.4) | 1.4 | 0.4 (-0.6, 1.4) |
Lancaster County | 8 | falling | similar | 21 | 149.0 (116.1, 192.2) | 1.2 | -1.8 (-2.6, -1.0) |
Goochland County | 8 | falling | similar | 22 | 116.1 (94.4, 142.3) | 0.9 | -1.7 (-2.9, -0.5) |
Giles County | 8 | falling | similar | 22 | 153.4 (125.3, 187.2) | 1.2 | -1.0 (-1.9, -0.2) |
Bristol City | 6 | stable | similar | 23 | 148.6 (121.5, 181.2) | 1.2 | -17.2 (-32.5, 1.7) |
Powhatan County | 8 | falling | similar | 23 | 114.9 (94.3, 139.4) | 0.9 | -15.4 (-27.7, -1.0) |
Martinsville City | 4 | stable | higher | 24 | 221.6 (182.5, 267.8) | 1.7 | 0.6 (-0.3, 1.6) |
Grayson County | 4 | stable | higher | 24 | 161.1 (132.6, 196.0) | 1.3 | 0.0 (-1.1, 1.2) |
Westmoreland County | 8 | falling | similar | 24 | 140.9 (115.3, 171.9) | 1.1 | -1.0 (-1.7, -0.4) |
Prince Edward County | 8 | falling | similar | 24 | 155.3 (127.0, 188.6) | 1.2 | -0.9 (-1.7, 0.0) |
Colonial Heights City | 4 | stable | higher | 25 | 167.6 (138.2, 202.2) | 1.3 | -0.6 (-1.3, 0.1) |
Rockbridge County | 8 | falling | similar | 26 | 110.9 (91.8, 134.0) | 0.9 | -1.6 (-2.3, -1.0) |
Harrisonburg City | 8 | falling | similar | 26 | 112.7 (93.5, 134.6) | 0.9 | -1.2 (-2.2, -0.3) |
Prince George County | 8 | falling | similar | 26 | 121.0 (100.7, 144.4) | 0.9 | -1.7 (-2.7, -0.7) |
Fairfax City | 5 | falling | higher | 27 | 172.8 (144.0, 206.2) | 1.3 | -1.4 (-2.4, -0.4) |
Patrick County | 4 | stable | higher | 28 | 156.8 (130.4, 188.7) | 1.2 | -0.1 (-1.1, 0.9) |
Winchester City | 8 | falling | similar | 28 | 147.2 (123.2, 174.8) | 1.1 | -1.5 (-2.3, -0.8) |
Dinwiddie County | 6 | stable | similar | 28 | 134.1 (112.3, 159.3) | 1.0 | -0.6 (-1.6, 0.3) |
Manassas City | 8 | falling | similar | 28 | 151.0 (126.2, 179.1) | 1.2 | -1.2 (-2.4, 0.0) |
Charlottesville City | 8 | falling | similar | 29 | 124.5 (104.7, 147.0) | 1.0 | -1.6 (-2.2, -1.0) |
Fluvanna County | 8 | falling | similar | 29 | 135.2 (113.9, 160.0) | 1.1 | -1.1 (-1.9, -0.3) |
Page County | 6 | stable | similar | 30 | 148.4 (124.8, 176.0) | 1.2 | -0.1 (-1.1, 0.9) |
Hopewell City | 4 | stable | higher | 30 | 186.8 (157.3, 220.6) | 1.5 | 0.0 (-0.8, 0.9) |
Waynesboro City | 4 | stable | higher | 31 | 177.5 (149.8, 209.4) | 1.4 | 0.0 (-0.7, 0.8) |
Buchanan County | 4 | stable | higher | 32 | 178.0 (150.0, 210.7) | 1.4 | -0.6 (-1.4, 0.3) |
Lee County | 4 | stable | higher | 32 | 160.2 (135.4, 189.1) | 1.2 | 0.6 (-0.3, 1.5) |
Botetourt County | 7 | stable | lower | 32 | 110.7 (94.0, 130.4) | 0.9 | -0.5 (-1.2, 0.1) |
Caroline County | 5 | falling | higher | 33 | 155.1 (131.7, 181.7) | 1.2 | -0.7 (-1.4, -0.1) |
Scott County | 4 | stable | higher | 34 | 175.5 (148.6, 206.9) | 1.4 | 0.0 (-0.7, 0.7) |
Staunton City | 4 | stable | higher | 34 | 155.4 (132.1, 182.3) | 1.2 | -0.3 (-1.2, 0.6) |
Amherst County | 8 | falling | similar | 35 | 132.6 (112.9, 155.3) | 1.0 | -1.4 (-2.0, -0.8) |
Isle of Wight County | 8 | falling | similar | 36 | 122.7 (104.9, 143.2) | 1.0 | -1.0 (-1.8, -0.1) |
Pulaski County | 8 | falling | similar | 36 | 118.3 (101.0, 138.5) | 0.9 | -2.2 (-3.3, -1.0) |
Salem City | 4 | stable | higher | 36 | 178.9 (152.9, 208.8) | 1.4 | -0.2 (-1.1, 0.6) |
Carroll County | 6 | stable | similar | 37 | 131.4 (112.1, 153.8) | 1.0 | -0.4 (-1.1, 0.3) |
Russell County | 4 | stable | higher | 38 | 161.1 (137.9, 187.9) | 1.3 | -0.4 (-1.2, 0.3) |
Wythe County | 4 | stable | higher | 38 | 154.2 (132.2, 179.4) | 1.2 | -0.5 (-1.1, 0.1) |
Warren County | 8 | falling | similar | 38 | 141.4 (121.6, 163.7) | 1.1 | -0.9 (-1.8, -0.1) |
Louisa County | 6 | stable | similar | 39 | 143.9 (123.9, 166.5) | 1.1 | -0.6 (-1.5, 0.4) |
Orange County | 8 | falling | similar | 40 | 132.6 (114.2, 153.5) | 1.0 | -1.1 (-1.9, -0.3) |
Smyth County | 4 | stable | higher | 43 | 162.4 (140.6, 187.2) | 1.3 | -0.4 (-1.0, 0.3) |
Mecklenburg County | 8 | falling | similar | 45 | 145.6 (126.0, 168.2) | 1.1 | -1.0 (-1.5, -0.4) |
Culpeper County | 8 | falling | similar | 46 | 137.9 (120.3, 157.5) | 1.1 | -1.3 (-2.0, -0.6) |
Gloucester County | 5 | falling | higher | 47 | 162.4 (141.7, 185.8) | 1.3 | -0.9 (-1.6, -0.1) |
Wise County | 4 | stable | higher | 47 | 173.1 (151.0, 197.9) | 1.3 | -0.4 (-0.9, 0.2) |
Petersburg City | 5 | falling | higher | 48 | 208.5 (181.3, 238.9) | 1.6 | -0.9 (-1.7, -0.1) |
Accomack County | 5 | falling | higher | 50 | 176.0 (153.1, 201.9) | 1.4 | -0.6 (-1.1, -0.1) |
Halifax County with South Boston City | 4 | stable | higher | 50 | 163.8 (142.3, 188.0) | 1.3 | 0.1 (-0.5, 0.7) |
York County | 9 | falling | lower | 50 | 107.3 (94.2, 121.8) | 0.8 | -2.2 (-3.0, -1.4) |
Shenandoah County | 8 | falling | similar | 52 | 141.0 (123.8, 160.3) | 1.1 | -0.8 (-1.2, -0.3) |
Danville City | 8 | falling | similar | 54 | 143.6 (126.0, 163.4) | 1.1 | -0.8 (-1.3, -0.2) |
Montgomery County | 9 | falling | lower | 55 | 103.1 (91.0, 116.5) | 0.8 | -1.9 (-2.5, -1.3) |
Tazewell County | 4 | stable | higher | 58 | 160.0 (141.2, 181.1) | 1.2 | -0.3 (-0.9, 0.2) |
Franklin County | 8 | falling | similar | 60 | 125.4 (110.8, 141.7) | 1.0 | -0.9 (-1.6, -0.2) |
Fauquier County | 8 | falling | similar | 61 | 126.7 (112.6, 142.1) | 1.0 | -1.6 (-2.4, -0.9) |
Campbell County | 8 | falling | similar | 63 | 139.5 (124.0, 156.6) | 1.1 | -0.7 (-1.3, -0.2) |
Pittsylvania County | 6 | stable | similar | 65 | 122.6 (109.0, 137.8) | 1.0 | -0.5 (-1.1, 0.0) |
Henry County | 6 | stable | similar | 66 | 141.0 (125.0, 158.8) | 1.1 | 0.4 (-0.2, 1.1) |
Washington County | 2 | rising | similar | 67 | 142.1 (126.4, 159.6) | 1.1 | 7.6 (1.6, 13.9) |
Augusta County | 7 | stable | lower | 70 | 111.3 (99.6, 124.1) | 0.9 | 3.4 (-8.3, 16.7) |
Lynchburg City | 5 | falling | higher | 75 | 148.2 (132.8, 165.0) | 1.2 | -0.8 (-1.2, -0.4) |
Rockingham County | 6 | stable | similar | 76 | 118.1 (106.2, 131.1) | 0.9 | -0.6 (-1.3, 0.0) |
Alexandria City | 9 | falling | lower | 82 | 99.3 (89.7, 109.7) | 0.8 | -2.8 (-3.2, -2.3) |
Suffolk City | 5 | falling | higher | 83 | 144.1 (130.3, 158.9) | 1.1 | -1.5 (-2.1, -1.0) |
Bedford City and County | 8 | falling | similar | 84 | 126.1 (114.0, 139.4) | 1.0 | -0.6 (-1.1, -0.1) |
James City County | 8 | falling | similar | 85 | 117.8 (106.1, 130.7) | 0.9 | -1.4 (-2.1, -0.8) |
Frederick County | 8 | falling | similar | 87 | 141.5 (128.3, 156.0) | 1.1 | -1.1 (-1.6, -0.5) |
Albemarle County | 9 | falling | lower | 88 | 102.2 (92.6, 112.7) | 0.8 | -1.5 (-2.0, -1.0) |
Stafford County | 8 | falling | similar | 89 | 126.5 (114.7, 139.2) | 1.0 | -1.4 (-2.0, -0.8) |
Roanoke County | 9 | falling | lower | 95 | 111.7 (101.4, 122.8) | 0.9 | -0.9 (-1.4, -0.4) |
Arlington County | 9 | falling | lower | 106 | 95.8 (87.6, 104.5) | 0.7 | -3.5 (-4.3, -2.6) |
Spotsylvania County | 8 | falling | similar | 106 | 130.3 (119.3, 142.2) | 1.0 | -1.8 (-2.4, -1.2) |
Hanover County | 8 | falling | similar | 109 | 138.7 (127.0, 151.3) | 1.1 | -1.1 (-1.5, -0.6) |
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) |
Hampton City | 8 | falling | similar | 127 | 139.8 (128.9, 151.5) | 1.1 | -1.2 (-1.6, -0.9) |
Newport News City | 5 | falling | higher | 167 | 153.1 (142.7, 164.0) | 1.2 | -0.8 (-1.2, -0.4) |
Richmond City | 8 | falling | similar | 175 | 127.0 (118.4, 136.1) | 1.0 | -3.0 (-3.7, -2.2) |
Loudoun County | 9 | falling | lower | 188 | 105.3 (98.6, 112.4) | 0.8 | -2.3 (-2.7, -1.8) |
Norfolk City | 5 | falling | higher | 195 | 153.3 (143.6, 163.6) | 1.2 | -1.4 (-1.7, -1.1) |
Chesapeake City | 8 | falling | similar | 203 | 140.7 (132.1, 149.9) | 1.1 | -1.3 (-1.6, -0.9) |
Prince William County | 8 | falling | similar | 245 | 116.1 (109.5, 123.1) | 0.9 | -2.1 (-2.4, -1.8) |
Chesterfield County | 8 | falling | similar | 283 | 130.0 (123.1, 137.1) | 1.0 | -1.2 (-1.5, -0.9) |
Henrico County | 8 | falling | similar | 310 | 134.5 (127.7, 141.6) | 1.0 | -1.0 (-1.2, -0.8) |
Virginia Beach City | 8 | falling | similar | 363 | 128.7 (122.8, 134.9) | 1.0 | -1.3 (-1.6, -1.0) |
Fairfax County | 9 | falling | lower | 634 | 95.8 (92.4, 99.2) | 0.7 | -2.2 (-2.4, -2.0) |
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 05/18/2024 7:05 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 05/18/2024 7:05 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.