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) |
Williamsburg City | 9 | falling | lower | 7 | 65.1 (44.0, 95.0) | 0.5 | -3.9 (-5.4, -2.4) |
Rappahannock County | 9 | falling | lower | 7 | 89.3 (60.2, 132.9) | 0.7 | -1.6 (-2.8, -0.3) |
Fairfax County | 9 | falling | lower | 634 | 95.8 (92.4, 99.2) | 0.7 | -2.2 (-2.4, -2.0) |
Arlington County | 9 | falling | lower | 106 | 95.8 (87.6, 104.5) | 0.7 | -3.5 (-4.3, -2.6) |
Alexandria City | 9 | falling | lower | 82 | 99.3 (89.7, 109.7) | 0.8 | -2.8 (-3.2, -2.3) |
Albemarle County | 9 | falling | lower | 88 | 102.2 (92.6, 112.7) | 0.8 | -1.5 (-2.0, -1.0) |
Montgomery County | 9 | falling | lower | 55 | 103.1 (91.0, 116.5) | 0.8 | -1.9 (-2.5, -1.3) |
Loudoun County | 9 | falling | lower | 188 | 105.3 (98.6, 112.4) | 0.8 | -2.3 (-2.7, -1.8) |
York County | 9 | falling | lower | 50 | 107.3 (94.2, 121.8) | 0.8 | -2.2 (-3.0, -1.4) |
Buckingham County | 6 | stable | similar | 14 | 107.6 (83.0, 138.7) | 0.8 | -1.2 (-2.4, 0.0) |
Falls Church City | 8 | falling | similar | 9 | 107.6 (78.7, 144.4) | 0.8 | -2.6 (-3.8, -1.5) |
Greene County | 8 | falling | similar | 15 | 108.1 (84.4, 137.1) | 0.8 | -2.1 (-3.2, -1.0) |
King George County | 8 | falling | similar | 16 | 109.5 (86.5, 137.0) | 0.9 | -5.2 (-7.9, -2.4) |
Botetourt County | 7 | stable | lower | 32 | 110.7 (94.0, 130.4) | 0.9 | -0.5 (-1.2, 0.1) |
Rockbridge County | 8 | falling | similar | 26 | 110.9 (91.8, 134.0) | 0.9 | -1.6 (-2.3, -1.0) |
Augusta County | 7 | stable | lower | 70 | 111.3 (99.6, 124.1) | 0.9 | 3.4 (-8.3, 16.7) |
Roanoke County | 9 | falling | lower | 95 | 111.7 (101.4, 122.8) | 0.9 | -0.9 (-1.4, -0.4) |
Fredericksburg City | 8 | falling | similar | 16 | 111.7 (88.5, 139.1) | 0.9 | -2.3 (-3.3, -1.3) |
Harrisonburg City | 8 | falling | similar | 26 | 112.7 (93.5, 134.6) | 0.9 | -1.2 (-2.2, -0.3) |
Clarke County | 8 | falling | similar | 14 | 113.7 (87.8, 146.6) | 0.9 | -1.7 (-2.7, -0.7) |
Northampton County | 8 | falling | similar | 14 | 114.1 (86.8, 150.0) | 0.9 | -5.4 (-7.5, -3.3) |
Bland County | 6 | stable | similar | 6 | 114.2 (77.6, 168.9) | 0.9 | -1.0 (-2.7, 0.8) |
Northumberland County | 8 | falling | similar | 19 | 114.5 (91.8, 145.8) | 0.9 | -1.6 (-2.4, -0.8) |
Powhatan County | 8 | falling | similar | 23 | 114.9 (94.3, 139.4) | 0.9 | -15.4 (-27.7, -1.0) |
Goochland County | 8 | falling | similar | 22 | 116.1 (94.4, 142.3) | 0.9 | -1.7 (-2.9, -0.5) |
Prince William County | 8 | falling | similar | 245 | 116.1 (109.5, 123.1) | 0.9 | -2.1 (-2.4, -1.8) |
James City County | 8 | falling | similar | 85 | 117.8 (106.1, 130.7) | 0.9 | -1.4 (-2.1, -0.8) |
Rockingham County | 6 | stable | similar | 76 | 118.1 (106.2, 131.1) | 0.9 | -0.6 (-1.3, 0.0) |
Pulaski County | 8 | falling | similar | 36 | 118.3 (101.0, 138.5) | 0.9 | -2.2 (-3.3, -1.0) |
Prince George County | 8 | falling | similar | 26 | 121.0 (100.7, 144.4) | 0.9 | -1.7 (-2.7, -0.7) |
Mathews County | 8 | falling | similar | 12 | 121.5 (91.6, 163.2) | 0.9 | -2.1 (-3.2, -1.1) |
Southampton County | 6 | stable | similar | 17 | 121.7 (96.2, 153.1) | 0.9 | -0.8 (-1.8, 0.3) |
King William County | 8 | falling | similar | 14 | 122.4 (95.0, 155.9) | 1.0 | -1.6 (-2.7, -0.5) |
Pittsylvania County | 6 | stable | similar | 65 | 122.6 (109.0, 137.8) | 1.0 | -0.5 (-1.1, 0.0) |
Isle of Wight County | 8 | falling | similar | 36 | 122.7 (104.9, 143.2) | 1.0 | -1.0 (-1.8, -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) |
Floyd County | 6 | stable | similar | 16 | 123.3 (95.8, 157.5) | 1.0 | -0.3 (-1.6, 1.0) |
Nelson County | 6 | stable | similar | 18 | 124.2 (98.8, 156.2) | 1.0 | -0.9 (-2.1, 0.4) |
Charlottesville City | 8 | falling | similar | 29 | 124.5 (104.7, 147.0) | 1.0 | -1.6 (-2.2, -1.0) |
Franklin County | 8 | falling | similar | 60 | 125.4 (110.8, 141.7) | 1.0 | -0.9 (-1.6, -0.2) |
Bedford City and County | 8 | falling | similar | 84 | 126.1 (114.0, 139.4) | 1.0 | -0.6 (-1.1, -0.1) |
Stafford County | 8 | falling | similar | 89 | 126.5 (114.7, 139.2) | 1.0 | -1.4 (-2.0, -0.8) |
Fauquier County | 8 | falling | similar | 61 | 126.7 (112.6, 142.1) | 1.0 | -1.6 (-2.4, -0.9) |
Richmond City | 8 | falling | similar | 175 | 127.0 (118.4, 136.1) | 1.0 | -3.0 (-3.7, -2.2) |
Virginia Beach City | 8 | falling | similar | 363 | 128.7 (122.8, 134.9) | 1.0 | -1.3 (-1.6, -1.0) |
Chesterfield County | 8 | falling | similar | 283 | 130.0 (123.1, 137.1) | 1.0 | -1.2 (-1.5, -0.9) |
Spotsylvania County | 8 | falling | similar | 106 | 130.3 (119.3, 142.2) | 1.0 | -1.8 (-2.4, -1.2) |
Appomattox County | 6 | stable | similar | 16 | 130.4 (102.6, 164.4) | 1.0 | -0.1 (-1.3, 1.2) |
Carroll County | 6 | stable | similar | 37 | 131.4 (112.1, 153.8) | 1.0 | -0.4 (-1.1, 0.3) |
Middlesex County | 6 | stable | similar | 16 | 131.6 (102.5, 170.4) | 1.0 | -0.3 (-1.5, 0.9) |
Orange County | 8 | falling | similar | 40 | 132.6 (114.2, 153.5) | 1.0 | -1.1 (-1.9, -0.3) |
Amherst County | 8 | falling | similar | 35 | 132.6 (112.9, 155.3) | 1.0 | -1.4 (-2.0, -0.8) |
Dinwiddie County | 6 | stable | similar | 28 | 134.1 (112.3, 159.3) | 1.0 | -0.6 (-1.6, 0.3) |
Madison County | 6 | stable | similar | 14 | 134.3 (102.7, 173.8) | 1.0 | -0.9 (-1.9, 0.2) |
Radford City | 6 | stable | similar | 10 | 134.4 (99.7, 177.8) | 1.0 | -0.9 (-2.3, 0.4) |
Henrico County | 8 | falling | similar | 310 | 134.5 (127.7, 141.6) | 1.0 | -1.0 (-1.2, -0.8) |
Fluvanna County | 8 | falling | similar | 29 | 135.2 (113.9, 160.0) | 1.1 | -1.1 (-1.9, -0.3) |
Culpeper County | 8 | falling | similar | 46 | 137.9 (120.3, 157.5) | 1.1 | -1.3 (-2.0, -0.6) |
Lunenburg County | 6 | stable | similar | 14 | 138.2 (105.7, 179.4) | 1.1 | -0.6 (-1.5, 0.3) |
Hanover County | 8 | falling | similar | 109 | 138.7 (127.0, 151.3) | 1.1 | -1.1 (-1.5, -0.6) |
Campbell County | 8 | falling | similar | 63 | 139.5 (124.0, 156.6) | 1.1 | -0.7 (-1.3, -0.2) |
Hampton City | 8 | falling | similar | 127 | 139.8 (128.9, 151.5) | 1.1 | -1.2 (-1.6, -0.9) |
Chesapeake City | 8 | falling | similar | 203 | 140.7 (132.1, 149.9) | 1.1 | -1.3 (-1.6, -0.9) |
Westmoreland County | 8 | falling | similar | 24 | 140.9 (115.3, 171.9) | 1.1 | -1.0 (-1.7, -0.4) |
Shenandoah County | 8 | falling | similar | 52 | 141.0 (123.8, 160.3) | 1.1 | -0.8 (-1.2, -0.3) |
Henry County | 6 | stable | similar | 66 | 141.0 (125.0, 158.8) | 1.1 | 0.4 (-0.2, 1.1) |
Surry County | 6 | stable | similar | 8 | 141.2 (98.2, 200.9) | 1.1 | -0.6 (-2.2, 1.0) |
Warren County | 8 | falling | similar | 38 | 141.4 (121.6, 163.7) | 1.1 | -0.9 (-1.8, -0.1) |
Frederick County | 8 | falling | similar | 87 | 141.5 (128.3, 156.0) | 1.1 | -1.1 (-1.6, -0.5) |
Washington County | 2 | rising | similar | 67 | 142.1 (126.4, 159.6) | 1.1 | 7.6 (1.6, 13.9) |
Poquoson City | 8 | falling | similar | 13 | 143.0 (110.2, 184.2) | 1.1 | -2.3 (-3.8, -0.7) |
Charlotte County | 6 | stable | similar | 15 | 143.1 (111.5, 182.9) | 1.1 | -0.9 (-1.9, 0.0) |
New Kent County | 8 | falling | similar | 20 | 143.3 (115.6, 176.1) | 1.1 | -1.3 (-2.2, -0.4) |
Essex County | 6 | stable | similar | 14 | 143.3 (109.6, 186.1) | 1.1 | -0.9 (-1.9, 0.2) |
Danville City | 8 | falling | similar | 54 | 143.6 (126.0, 163.4) | 1.1 | -0.8 (-1.3, -0.2) |
Louisa County | 6 | stable | similar | 39 | 143.9 (123.9, 166.5) | 1.1 | -0.6 (-1.5, 0.4) |
Suffolk City | 5 | falling | higher | 83 | 144.1 (130.3, 158.9) | 1.1 | -1.5 (-2.1, -1.0) |
Charles City County | 6 | stable | similar | 10 | 144.7 (105.6, 198.9) | 1.1 | -1.3 (-2.7, 0.1) |
Mecklenburg County | 8 | falling | similar | 45 | 145.6 (126.0, 168.2) | 1.1 | -1.0 (-1.5, -0.4) |
Cumberland County | 6 | stable | similar | 12 | 146.0 (109.2, 193.0) | 1.1 | -0.3 (-1.7, 1.2) |
Emporia City | 6 | stable | similar | 6 | 146.7 (98.9, 212.4) | 1.1 | -1.4 (-2.8, 0.1) |
Winchester City | 8 | falling | similar | 28 | 147.2 (123.2, 174.8) | 1.1 | -1.5 (-2.3, -0.8) |
Lynchburg City | 5 | falling | higher | 75 | 148.2 (132.8, 165.0) | 1.2 | -0.8 (-1.2, -0.4) |
Page County | 6 | stable | similar | 30 | 148.4 (124.8, 176.0) | 1.2 | -0.1 (-1.1, 0.9) |
Bristol City | 6 | stable | similar | 23 | 148.6 (121.5, 181.2) | 1.2 | -17.2 (-32.5, 1.7) |
Lancaster County | 8 | falling | similar | 21 | 149.0 (116.1, 192.2) | 1.2 | -1.8 (-2.6, -1.0) |
King and Queen County | 6 | stable | similar | 9 | 149.6 (107.2, 207.5) | 1.2 | 0.0 (-1.4, 1.4) |
Manassas City | 8 | falling | similar | 28 | 151.0 (126.2, 179.1) | 1.2 | -1.2 (-2.4, 0.0) |
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) |
Giles County | 8 | falling | similar | 22 | 153.4 (125.3, 187.2) | 1.2 | -1.0 (-1.9, -0.2) |
Norton City | 6 | stable | similar | 5 | 153.5 (99.1, 232.2) | 1.2 | -0.6 (-2.1, 1.0) |
Wythe County | 4 | stable | higher | 38 | 154.2 (132.2, 179.4) | 1.2 | -0.5 (-1.1, 0.1) |
Caroline County | 5 | falling | higher | 33 | 155.1 (131.7, 181.7) | 1.2 | -0.7 (-1.4, -0.1) |
Brunswick County | 8 | falling | similar | 21 | 155.2 (124.4, 192.7) | 1.2 | -1.2 (-2.4, 0.0) |
Prince Edward County | 8 | falling | similar | 24 | 155.3 (127.0, 188.6) | 1.2 | -0.9 (-1.7, 0.0) |
Staunton City | 4 | stable | higher | 34 | 155.4 (132.1, 182.3) | 1.2 | -0.3 (-1.2, 0.6) |
Patrick County | 4 | stable | higher | 28 | 156.8 (130.4, 188.7) | 1.2 | -0.1 (-1.1, 0.9) |
Tazewell County | 4 | stable | higher | 58 | 160.0 (141.2, 181.1) | 1.2 | -0.3 (-0.9, 0.2) |
Lee County | 4 | stable | higher | 32 | 160.2 (135.4, 189.1) | 1.2 | 0.6 (-0.3, 1.5) |
Richmond County | 6 | stable | similar | 14 | 160.9 (123.8, 210.2) | 1.2 | -0.6 (-1.8, 0.7) |
Amelia County | 6 | stable | similar | 17 | 161.0 (126.7, 203.2) | 1.3 | 0.0 (-1.2, 1.1) |
Russell County | 4 | stable | higher | 38 | 161.1 (137.9, 187.9) | 1.3 | -0.4 (-1.2, 0.3) |
Grayson County | 4 | stable | higher | 24 | 161.1 (132.6, 196.0) | 1.3 | 0.0 (-1.1, 1.2) |
Buena Vista City | 6 | stable | similar | 9 | 162.4 (116.3, 223.3) | 1.3 | -1.2 (-2.6, 0.2) |
Smyth County | 4 | stable | higher | 43 | 162.4 (140.6, 187.2) | 1.3 | -0.4 (-1.0, 0.3) |
Lexington City | 6 | stable | similar | 8 | 162.4 (113.1, 233.1) | 1.3 | -1.7 (-3.6, 0.3) |
Gloucester County | 5 | falling | higher | 47 | 162.4 (141.7, 185.8) | 1.3 | -0.9 (-1.6, -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) |
Roanoke City | 5 | falling | higher | 120 | 165.2 (151.7, 179.6) | 1.3 | -0.5 (-0.8, -0.1) |
Nottoway County | 4 | stable | higher | 19 | 165.5 (132.7, 205.2) | 1.3 | -0.1 (-1.1, 0.9) |
Colonial Heights City | 4 | stable | higher | 25 | 167.6 (138.2, 202.2) | 1.3 | -0.6 (-1.3, 0.1) |
Portsmouth City | 5 | falling | higher | 109 | 172.5 (158.0, 188.1) | 1.3 | -0.7 (-1.1, -0.2) |
Fairfax City | 5 | falling | higher | 27 | 172.8 (144.0, 206.2) | 1.3 | -1.4 (-2.4, -0.4) |
Wise County | 4 | stable | higher | 47 | 173.1 (151.0, 197.9) | 1.3 | -0.4 (-0.9, 0.2) |
Scott County | 4 | stable | higher | 34 | 175.5 (148.6, 206.9) | 1.4 | 0.0 (-0.7, 0.7) |
Accomack County | 5 | falling | higher | 50 | 176.0 (153.1, 201.9) | 1.4 | -0.6 (-1.1, -0.1) |
Dickenson County | 4 | stable | higher | 21 | 176.5 (142.5, 217.4) | 1.4 | 0.4 (-0.6, 1.4) |
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) |
Salem City | 4 | stable | higher | 36 | 178.9 (152.9, 208.8) | 1.4 | -0.2 (-1.1, 0.6) |
Franklin City | 5 | falling | higher | 12 | 179.2 (133.8, 236.7) | 1.4 | -1.4 (-2.5, -0.3) |
Covington City | 6 | stable | similar | 9 | 186.0 (131.6, 258.1) | 1.4 | 1.0 (-0.7, 2.6) |
Hopewell City | 4 | stable | higher | 30 | 186.8 (157.3, 220.6) | 1.5 | 0.0 (-0.8, 0.9) |
Bath County | 4 | stable | higher | 8 | 194.1 (136.4, 276.9) | 1.5 | 0.4 (-0.9, 1.8) |
Sussex County | 4 | stable | higher | 15 | 198.7 (154.9, 253.5) | 1.5 | -0.1 (-1.3, 1.1) |
Petersburg City | 5 | falling | higher | 48 | 208.5 (181.3, 238.9) | 1.6 | -0.9 (-1.7, -0.1) |
Greensville County | 1 | rising | higher | 14 | 217.1 (166.6, 280.0) | 1.7 | 1.6 (0.4, 2.8) |
Martinsville City | 4 | stable | higher | 24 | 221.6 (182.5, 267.8) | 1.7 | 0.6 (-0.3, 1.6) |
Galax City | 4 | stable | higher | 17 | 324.5 (256.0, 407.9) | 2.5 | -14.0 (-36.5, 16.4) |
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 05/18/2024 11:52 am.
* 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 11:52 am.
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.