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) |
Nottoway County | 4 | stable | higher | 19 | 165.5 (132.7, 205.2) | 1.3 | -0.1 (-1.1, 0.9) |
Page County | 6 | stable | similar | 30 | 148.4 (124.8, 176.0) | 1.2 | -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) |
Sussex County | 4 | stable | higher | 15 | 198.7 (154.9, 253.5) | 1.5 | -0.1 (-1.3, 1.1) |
Appomattox County | 6 | stable | similar | 16 | 130.4 (102.6, 164.4) | 1.0 | -0.1 (-1.3, 1.2) |
Salem City | 4 | stable | higher | 36 | 178.9 (152.9, 208.8) | 1.4 | -0.2 (-1.1, 0.6) |
Tazewell County | 4 | stable | higher | 58 | 160.0 (141.2, 181.1) | 1.2 | -0.3 (-0.9, 0.2) |
Staunton City | 4 | stable | higher | 34 | 155.4 (132.1, 182.3) | 1.2 | -0.3 (-1.2, 0.6) |
Middlesex County | 6 | stable | similar | 16 | 131.6 (102.5, 170.4) | 1.0 | -0.3 (-1.5, 0.9) |
Floyd County | 6 | stable | similar | 16 | 123.3 (95.8, 157.5) | 1.0 | -0.3 (-1.6, 1.0) |
Cumberland County | 6 | stable | similar | 12 | 146.0 (109.2, 193.0) | 1.1 | -0.3 (-1.7, 1.2) |
Wise County | 4 | stable | higher | 47 | 173.1 (151.0, 197.9) | 1.3 | -0.4 (-0.9, 0.2) |
Smyth County | 4 | stable | higher | 43 | 162.4 (140.6, 187.2) | 1.3 | -0.4 (-1.0, 0.3) |
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) |
Roanoke City | 5 | falling | higher | 120 | 165.2 (151.7, 179.6) | 1.3 | -0.5 (-0.8, -0.1) |
Pittsylvania County | 6 | stable | similar | 65 | 122.6 (109.0, 137.8) | 1.0 | -0.5 (-1.1, 0.0) |
Wythe County | 4 | stable | higher | 38 | 154.2 (132.2, 179.4) | 1.2 | -0.5 (-1.1, 0.1) |
Botetourt County | 7 | stable | lower | 32 | 110.7 (94.0, 130.4) | 0.9 | -0.5 (-1.2, 0.1) |
Accomack County | 5 | falling | higher | 50 | 176.0 (153.1, 201.9) | 1.4 | -0.6 (-1.1, -0.1) |
Bedford City and County | 8 | falling | similar | 84 | 126.1 (114.0, 139.4) | 1.0 | -0.6 (-1.1, -0.1) |
Rockingham County | 6 | stable | similar | 76 | 118.1 (106.2, 131.1) | 0.9 | -0.6 (-1.3, 0.0) |
Colonial Heights City | 4 | stable | higher | 25 | 167.6 (138.2, 202.2) | 1.3 | -0.6 (-1.3, 0.1) |
Buchanan County | 4 | stable | higher | 32 | 178.0 (150.0, 210.7) | 1.4 | -0.6 (-1.4, 0.3) |
Lunenburg County | 6 | stable | similar | 14 | 138.2 (105.7, 179.4) | 1.1 | -0.6 (-1.5, 0.3) |
Louisa County | 6 | stable | similar | 39 | 143.9 (123.9, 166.5) | 1.1 | -0.6 (-1.5, 0.4) |
Dinwiddie County | 6 | stable | similar | 28 | 134.1 (112.3, 159.3) | 1.0 | -0.6 (-1.6, 0.3) |
Richmond County | 6 | stable | similar | 14 | 160.9 (123.8, 210.2) | 1.2 | -0.6 (-1.8, 0.7) |
Norton City | 6 | stable | similar | 5 | 153.5 (99.1, 232.2) | 1.2 | -0.6 (-2.1, 1.0) |
Surry County | 6 | stable | similar | 8 | 141.2 (98.2, 200.9) | 1.1 | -0.6 (-2.2, 1.0) |
Portsmouth City | 5 | falling | higher | 109 | 172.5 (158.0, 188.1) | 1.3 | -0.7 (-1.1, -0.2) |
Campbell County | 8 | falling | similar | 63 | 139.5 (124.0, 156.6) | 1.1 | -0.7 (-1.3, -0.2) |
Caroline County | 5 | falling | higher | 33 | 155.1 (131.7, 181.7) | 1.2 | -0.7 (-1.4, -0.1) |
Shenandoah County | 8 | falling | similar | 52 | 141.0 (123.8, 160.3) | 1.1 | -0.8 (-1.2, -0.3) |
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) |
Danville City | 8 | falling | similar | 54 | 143.6 (126.0, 163.4) | 1.1 | -0.8 (-1.3, -0.2) |
Southampton County | 6 | stable | similar | 17 | 121.7 (96.2, 153.1) | 0.9 | -0.8 (-1.8, 0.3) |
Roanoke County | 9 | falling | lower | 95 | 111.7 (101.4, 122.8) | 0.9 | -0.9 (-1.4, -0.4) |
Gloucester County | 5 | falling | higher | 47 | 162.4 (141.7, 185.8) | 1.3 | -0.9 (-1.6, -0.1) |
Franklin County | 8 | falling | similar | 60 | 125.4 (110.8, 141.7) | 1.0 | -0.9 (-1.6, -0.2) |
Petersburg City | 5 | falling | higher | 48 | 208.5 (181.3, 238.9) | 1.6 | -0.9 (-1.7, -0.1) |
Prince Edward County | 8 | falling | similar | 24 | 155.3 (127.0, 188.6) | 1.2 | -0.9 (-1.7, 0.0) |
Warren County | 8 | falling | similar | 38 | 141.4 (121.6, 163.7) | 1.1 | -0.9 (-1.8, -0.1) |
Charlotte County | 6 | stable | similar | 15 | 143.1 (111.5, 182.9) | 1.1 | -0.9 (-1.9, 0.0) |
Essex County | 6 | stable | similar | 14 | 143.3 (109.6, 186.1) | 1.1 | -0.9 (-1.9, 0.2) |
Madison County | 6 | stable | similar | 14 | 134.3 (102.7, 173.8) | 1.0 | -0.9 (-1.9, 0.2) |
Nelson County | 6 | stable | similar | 18 | 124.2 (98.8, 156.2) | 1.0 | -0.9 (-2.1, 0.4) |
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) |
Mecklenburg County | 8 | falling | similar | 45 | 145.6 (126.0, 168.2) | 1.1 | -1.0 (-1.5, -0.4) |
Westmoreland County | 8 | falling | similar | 24 | 140.9 (115.3, 171.9) | 1.1 | -1.0 (-1.7, -0.4) |
Isle of Wight County | 8 | falling | similar | 36 | 122.7 (104.9, 143.2) | 1.0 | -1.0 (-1.8, -0.1) |
Giles County | 8 | falling | similar | 22 | 153.4 (125.3, 187.2) | 1.2 | -1.0 (-1.9, -0.2) |
Bland County | 6 | stable | similar | 6 | 114.2 (77.6, 168.9) | 0.9 | -1.0 (-2.7, 0.8) |
Hanover County | 8 | falling | similar | 109 | 138.7 (127.0, 151.3) | 1.1 | -1.1 (-1.5, -0.6) |
Frederick County | 8 | falling | similar | 87 | 141.5 (128.3, 156.0) | 1.1 | -1.1 (-1.6, -0.5) |
Fluvanna County | 8 | falling | similar | 29 | 135.2 (113.9, 160.0) | 1.1 | -1.1 (-1.9, -0.3) |
Orange County | 8 | falling | similar | 40 | 132.6 (114.2, 153.5) | 1.0 | -1.1 (-1.9, -0.3) |
Chesterfield County | 8 | falling | similar | 283 | 130.0 (123.1, 137.1) | 1.0 | -1.2 (-1.5, -0.9) |
Hampton City | 8 | falling | similar | 127 | 139.8 (128.9, 151.5) | 1.1 | -1.2 (-1.6, -0.9) |
Harrisonburg City | 8 | falling | similar | 26 | 112.7 (93.5, 134.6) | 0.9 | -1.2 (-2.2, -0.3) |
Brunswick County | 8 | falling | similar | 21 | 155.2 (124.4, 192.7) | 1.2 | -1.2 (-2.4, 0.0) |
Buckingham County | 6 | stable | similar | 14 | 107.6 (83.0, 138.7) | 0.8 | -1.2 (-2.4, 0.0) |
Manassas City | 8 | falling | similar | 28 | 151.0 (126.2, 179.1) | 1.2 | -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) |
Chesapeake City | 8 | falling | similar | 203 | 140.7 (132.1, 149.9) | 1.1 | -1.3 (-1.6, -0.9) |
Virginia Beach City | 8 | falling | similar | 363 | 128.7 (122.8, 134.9) | 1.0 | -1.3 (-1.6, -1.0) |
Culpeper County | 8 | falling | similar | 46 | 137.9 (120.3, 157.5) | 1.1 | -1.3 (-2.0, -0.6) |
New Kent County | 8 | falling | similar | 20 | 143.3 (115.6, 176.1) | 1.1 | -1.3 (-2.2, -0.4) |
Alleghany County and Clifton Forge City | 8 | falling | similar | 17 | 122.9 (96.6, 155.9) | 1.0 | -1.3 (-2.3, -0.3) |
Charles City County | 6 | stable | similar | 10 | 144.7 (105.6, 198.9) | 1.1 | -1.3 (-2.7, 0.1) |
Norfolk City | 5 | falling | higher | 195 | 153.3 (143.6, 163.6) | 1.2 | -1.4 (-1.7, -1.1) |
Amherst County | 8 | falling | similar | 35 | 132.6 (112.9, 155.3) | 1.0 | -1.4 (-2.0, -0.8) |
Stafford County | 8 | falling | similar | 89 | 126.5 (114.7, 139.2) | 1.0 | -1.4 (-2.0, -0.8) |
James City County | 8 | falling | similar | 85 | 117.8 (106.1, 130.7) | 0.9 | -1.4 (-2.1, -0.8) |
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) |
Emporia City | 6 | stable | similar | 6 | 146.7 (98.9, 212.4) | 1.1 | -1.4 (-2.8, 0.1) |
Albemarle County | 9 | falling | lower | 88 | 102.2 (92.6, 112.7) | 0.8 | -1.5 (-2.0, -1.0) |
Suffolk City | 5 | falling | higher | 83 | 144.1 (130.3, 158.9) | 1.1 | -1.5 (-2.1, -1.0) |
Winchester City | 8 | falling | similar | 28 | 147.2 (123.2, 174.8) | 1.1 | -1.5 (-2.3, -0.8) |
Charlottesville City | 8 | falling | similar | 29 | 124.5 (104.7, 147.0) | 1.0 | -1.6 (-2.2, -1.0) |
Rockbridge County | 8 | falling | similar | 26 | 110.9 (91.8, 134.0) | 0.9 | -1.6 (-2.3, -1.0) |
Northumberland County | 8 | falling | similar | 19 | 114.5 (91.8, 145.8) | 0.9 | -1.6 (-2.4, -0.8) |
Fauquier County | 8 | falling | similar | 61 | 126.7 (112.6, 142.1) | 1.0 | -1.6 (-2.4, -0.9) |
King William County | 8 | falling | similar | 14 | 122.4 (95.0, 155.9) | 1.0 | -1.6 (-2.7, -0.5) |
Rappahannock County | 9 | falling | lower | 7 | 89.3 (60.2, 132.9) | 0.7 | -1.6 (-2.8, -0.3) |
Clarke County | 8 | falling | similar | 14 | 113.7 (87.8, 146.6) | 0.9 | -1.7 (-2.7, -0.7) |
Prince George County | 8 | falling | similar | 26 | 121.0 (100.7, 144.4) | 0.9 | -1.7 (-2.7, -0.7) |
Goochland County | 8 | falling | similar | 22 | 116.1 (94.4, 142.3) | 0.9 | -1.7 (-2.9, -0.5) |
Lexington City | 6 | stable | similar | 8 | 162.4 (113.1, 233.1) | 1.3 | -1.7 (-3.6, 0.3) |
Spotsylvania County | 8 | falling | similar | 106 | 130.3 (119.3, 142.2) | 1.0 | -1.8 (-2.4, -1.2) |
Lancaster County | 8 | falling | similar | 21 | 149.0 (116.1, 192.2) | 1.2 | -1.8 (-2.6, -1.0) |
Montgomery County | 9 | falling | lower | 55 | 103.1 (91.0, 116.5) | 0.8 | -1.9 (-2.5, -1.3) |
Galax City | 4 | stable | higher | 17 | 324.5 (256.0, 407.9) | 2.5 | -14.0 (-36.5, 16.4) |
Powhatan County | 8 | falling | similar | 23 | 114.9 (94.3, 139.4) | 0.9 | -15.4 (-27.7, -1.0) |
Bristol City | 6 | stable | similar | 23 | 148.6 (121.5, 181.2) | 1.2 | -17.2 (-32.5, 1.7) |
Prince William County | 8 | falling | similar | 245 | 116.1 (109.5, 123.1) | 0.9 | -2.1 (-2.4, -1.8) |
Greene County | 8 | falling | similar | 15 | 108.1 (84.4, 137.1) | 0.8 | -2.1 (-3.2, -1.0) |
Mathews County | 8 | falling | similar | 12 | 121.5 (91.6, 163.2) | 0.9 | -2.1 (-3.2, -1.1) |
Fairfax County | 9 | falling | lower | 634 | 95.8 (92.4, 99.2) | 0.7 | -2.2 (-2.4, -2.0) |
York County | 9 | falling | lower | 50 | 107.3 (94.2, 121.8) | 0.8 | -2.2 (-3.0, -1.4) |
Pulaski County | 8 | falling | similar | 36 | 118.3 (101.0, 138.5) | 0.9 | -2.2 (-3.3, -1.0) |
Loudoun County | 9 | falling | lower | 188 | 105.3 (98.6, 112.4) | 0.8 | -2.3 (-2.7, -1.8) |
Fredericksburg City | 8 | falling | similar | 16 | 111.7 (88.5, 139.1) | 0.9 | -2.3 (-3.3, -1.3) |
Poquoson City | 8 | falling | similar | 13 | 143.0 (110.2, 184.2) | 1.1 | -2.3 (-3.8, -0.7) |
Falls Church City | 8 | falling | similar | 9 | 107.6 (78.7, 144.4) | 0.8 | -2.6 (-3.8, -1.5) |
Alexandria City | 9 | falling | lower | 82 | 99.3 (89.7, 109.7) | 0.8 | -2.8 (-3.2, -2.3) |
Richmond City | 8 | falling | similar | 175 | 127.0 (118.4, 136.1) | 1.0 | -3.0 (-3.7, -2.2) |
Arlington County | 9 | falling | lower | 106 | 95.8 (87.6, 104.5) | 0.7 | -3.5 (-4.3, -2.6) |
Williamsburg City | 9 | falling | lower | 7 | 65.1 (44.0, 95.0) | 0.5 | -3.9 (-5.4, -2.4) |
King George County | 8 | falling | similar | 16 | 109.5 (86.5, 137.0) | 0.9 | -5.2 (-7.9, -2.4) |
Northampton County | 8 | falling | similar | 14 | 114.1 (86.8, 150.0) | 0.9 | -5.4 (-7.5, -3.3) |
Scott County | 4 | stable | higher | 34 | 175.5 (148.6, 206.9) | 1.4 | 0.0 (-0.7, 0.7) |
Waynesboro City | 4 | stable | higher | 31 | 177.5 (149.8, 209.4) | 1.4 | 0.0 (-0.7, 0.8) |
Hopewell City | 4 | stable | higher | 30 | 186.8 (157.3, 220.6) | 1.5 | 0.0 (-0.8, 0.9) |
Grayson County | 4 | stable | higher | 24 | 161.1 (132.6, 196.0) | 1.3 | 0.0 (-1.1, 1.2) |
Amelia County | 6 | stable | similar | 17 | 161.0 (126.7, 203.2) | 1.3 | 0.0 (-1.2, 1.1) |
King and Queen County | 6 | stable | similar | 9 | 149.6 (107.2, 207.5) | 1.2 | 0.0 (-1.4, 1.4) |
Halifax County with South Boston City | 4 | stable | higher | 50 | 163.8 (142.3, 188.0) | 1.3 | 0.1 (-0.5, 0.7) |
Henry County | 6 | stable | similar | 66 | 141.0 (125.0, 158.8) | 1.1 | 0.4 (-0.2, 1.1) |
Dickenson County | 4 | stable | higher | 21 | 176.5 (142.5, 217.4) | 1.4 | 0.4 (-0.6, 1.4) |
Bath County | 4 | stable | higher | 8 | 194.1 (136.4, 276.9) | 1.5 | 0.4 (-0.9, 1.8) |
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) |
Covington City | 6 | stable | similar | 9 | 186.0 (131.6, 258.1) | 1.4 | 1.0 (-0.7, 2.6) |
Greensville County | 1 | rising | higher | 14 | 217.1 (166.6, 280.0) | 1.7 | 1.6 (0.4, 2.8) |
Augusta County | 7 | stable | lower | 70 | 111.3 (99.6, 124.1) | 0.9 | 3.4 (-8.3, 16.7) |
Washington County | 2 | rising | similar | 67 | 142.1 (126.4, 159.6) | 1.1 | 7.6 (1.6, 13.9) |
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 10:14 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 10:14 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.