Interpretation of Rate/Trend Comparison by Cancer Data
Death Rate/Trend Comparison by Cancer, 2016-2020
West Virginia Counties versus United States
Colon & Rectum
All Races, Both Sexes
Sorted by priority index
Explanation of Column HeadersState/County - The site and sex combination for this comparison.
Priority Index 1 - The priority index is based upon the direction of the trend and the rate comparison. An index of 1 is the highest priority - that trend is rising and the rate is already higher. An index of 9 is the lowest priority - the trend is falling and the rate is already lower.
Recent Trends - This is an interpretation of the AAPC:
- 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.
AAPC (95% Confidence Interval) - The Average Annual Percent Change is the change in rate over time. These AAPCs are based upon APCs that were calculated by Joinpoint Regression Program
Other Notes
- Larger confidence intervals indicate less stability of the data. This is often due to low counts that are not quite low enough to be suppressed.
- Data is currently being suppressed if there are fewer than 16 counts for the time period.
Line by Line Interpretation of the Report
United States
- Recent Trend(2) : The trend is falling because the trend is -1.9 with a 95% confidence interval from -2.1 to -1.8.
- Rate : The death rate is 13.1 with a 95% confidence interval from 13.1 to 13.2 and 52,152 average annual deaths.
West Virginia
- Recent Trend(2) : The trend is falling because the trend is -1.6 with a 95% confidence interval from -1.8 to -1.3.
- Rate : The death rate is 16.6 with a 95% confidence interval from 15.9 to 17.3 and 430 average annual deaths.
Lincoln County
- Priority Index(1) : The priority index is 4.
- Recent Trend(2) : The trend is stable because the trend is -0.1 with a 95% confidence interval from -2.0 to 1.9.
- County Death Rate Compared to US Rate : This death rate is higher compared to the US rate
- Rate : The death rate is 21.9 with a 95% confidence interval from 14.7 to 31.8 and 6 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.7
Logan County
- Priority Index(1) : The priority index is 4.
- Recent Trend(2) : The trend is stable because the trend is -1.0 with a 95% confidence interval from -2.4 to 0.5.
- County Death Rate Compared to US Rate : This death rate is higher compared to the US rate
- Rate : The death rate is 24.1 with a 95% confidence interval from 18.0 to 31.9 and 11 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.8
McDowell County
- Priority Index(1) : The priority index is 4.
- Recent Trend(2) : The trend is stable because the trend is 0.7 with a 95% confidence interval from -0.9 to 2.3.
- County Death Rate Compared to US Rate : This death rate is higher compared to the US rate
- Rate : The death rate is 34.3 with a 95% confidence interval from 25.0 to 46.4 and 10 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 2.6
Mercer County
- Priority Index(1) : The priority index is 4.
- Recent Trend(2) : The trend is stable because the trend is -0.1 with a 95% confidence interval from -1.1 to 0.8.
- County Death Rate Compared to US Rate : This death rate is higher compared to the US rate
- Rate : The death rate is 20.3 with a 95% confidence interval from 15.9 to 25.5 and 17 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.5
Mingo County
- Priority Index(1) : The priority index is 4.
- Recent Trend(2) : The trend is stable because the trend is -1.3 with a 95% confidence interval from -2.6 to 0.0.
- County Death Rate Compared to US Rate : This death rate is higher compared to the US rate
- Rate : The death rate is 22.7 with a 95% confidence interval from 15.8 to 31.9 and 7 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.7
Nicholas County
- Priority Index(1) : The priority index is 4.
- Recent Trend(2) : The trend is stable because the trend is -0.2 with a 95% confidence interval from -1.9 to 1.5.
- County Death Rate Compared to US Rate : This death rate is higher compared to the US rate
- Rate : The death rate is 22.6 with a 95% confidence interval from 16.0 to 31.4 and 8 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.7
Raleigh County
- Priority Index(1) : The priority index is 4.
- Recent Trend(2) : The trend is stable because the trend is -0.6 with a 95% confidence interval from -1.5 to 0.3.
- County Death Rate Compared to US Rate : This death rate is higher compared to the US rate
- Rate : The death rate is 17.4 with a 95% confidence interval from 13.9 to 21.5 and 19 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.3
Wood County
- Priority Index(1) : The priority index is 4.
- Recent Trend(2) : The trend is stable because the trend is -0.8 with a 95% confidence interval from -1.6 to 0.1.
- County Death Rate Compared to US Rate : This death rate is higher compared to the US rate
- Rate : The death rate is 18.3 with a 95% confidence interval from 14.9 to 22.2 and 22 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.4
Berkeley County
- Priority Index(1) : The priority index is 5.
- Recent Trend(2) : The trend is falling because the trend is -2.3 with a 95% confidence interval from -3.2 to -1.4.
- County Death Rate Compared to US Rate : This death rate is higher compared to the US rate
- Rate : The death rate is 16.7 with a 95% confidence interval from 13.6 to 20.3 and 22 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.3
Fayette County
- Priority Index(1) : The priority index is 5.
- Recent Trend(2) : The trend is falling because the trend is -1.3 with a 95% confidence interval from -2.3 to -0.3.
- County Death Rate Compared to US Rate : This death rate is higher compared to the US rate
- Rate : The death rate is 22.6 with a 95% confidence interval from 17.6 to 28.8 and 15 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.7
Boone County
- Priority Index(1) : The priority index is 6.
- Recent Trend(2) : The trend is stable because the trend is -1.0 with a 95% confidence interval from -2.9 to 0.9.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 14.2 with a 95% confidence interval from 8.7 to 22.3 and 4 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.1
Braxton County
- Priority Index(1) : The priority index is 6.
- Recent Trend(2) : The trend is stable because the trend is -1.7 with a 95% confidence interval from -3.6 to 0.3.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 18.4 with a 95% confidence interval from 11.2 to 29.4 and 4 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.4
Greenbrier County
- Priority Index(1) : The priority index is 6.
- Recent Trend(2) : The trend is stable because the trend is 0.1 with a 95% confidence interval from -1.3 to 1.5.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 18.0 with a 95% confidence interval from 13.1 to 24.4 and 10 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.4
Hampshire County
- Priority Index(1) : The priority index is 6.
- Recent Trend(2) : The trend is stable because the trend is -0.8 with a 95% confidence interval from -2.6 to 0.9.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 20.2 with a 95% confidence interval from 13.7 to 29.0 and 7 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.5
Mason County
- Priority Index(1) : The priority index is 6.
- Recent Trend(2) : The trend is stable because the trend is -1.2 with a 95% confidence interval from -2.8 to 0.5.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 14.7 with a 95% confidence interval from 9.7 to 21.8 and 6 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.1
Monroe County
- Priority Index(1) : The priority index is 6.
- Recent Trend(2) : The trend is stable because the trend is -1.3 with a 95% confidence interval from -3.2 to 0.8.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 17.3 with a 95% confidence interval from 10.7 to 27.9 and 4 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.3
Morgan County
- Priority Index(1) : The priority index is 6.
- Recent Trend(2) : The trend is stable because the trend is -1.8 with a 95% confidence interval from -3.7 to 0.0.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 18.9 with a 95% confidence interval from 11.7 to 29.4 and 5 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.4
Preston County
- Priority Index(1) : The priority index is 6.
- Recent Trend(2) : The trend is stable because the trend is -0.7 with a 95% confidence interval from -1.9 to 0.6.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 14.7 with a 95% confidence interval from 10.2 to 20.8 and 7 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.1
Randolph County
- Priority Index(1) : The priority index is 6.
- Recent Trend(2) : The trend is stable because the trend is -0.6 with a 95% confidence interval from -2.2 to 1.0.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 17.0 with a 95% confidence interval from 11.9 to 23.9 and 8 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.3
Wetzel County
- Priority Index(1) : The priority index is 6.
- Recent Trend(2) : The trend is stable because the trend is -1.3 with a 95% confidence interval from -2.9 to 0.4.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 21.4 with a 95% confidence interval from 13.5 to 33.0 and 5 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.6
Wyoming County
- Priority Index(1) : The priority index is 6.
- Recent Trend(2) : The trend is stable because the trend is 0.0 with a 95% confidence interval from -2.3 to 2.3.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 16.3 with a 95% confidence interval from 10.3 to 25.0 and 5 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.2
Barbour County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -1.5 with a 95% confidence interval from -2.8 to -0.1.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 19.1 with a 95% confidence interval from 11.5 to 30.1 and 4 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.5
Brooke County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -2.1 with a 95% confidence interval from -4.0 to -0.2.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 14.6 with a 95% confidence interval from 9.6 to 21.9 and 6 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.1
Cabell County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -1.8 with a 95% confidence interval from -2.5 to -1.0.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 14.9 with a 95% confidence interval from 11.9 to 18.4 and 19 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.1
Hancock County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -2.1 with a 95% confidence interval from -3.3 to -1.0.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 15.2 with a 95% confidence interval from 10.6 to 21.7 and 7 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.2
Harrison County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -2.0 with a 95% confidence interval from -3.0 to -1.1.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 15.1 with a 95% confidence interval from 11.8 to 19.1 and 15 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.1
Jackson County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -2.2 with a 95% confidence interval from -3.6 to -0.7.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 13.0 with a 95% confidence interval from 8.6 to 19.2 and 6 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.0
Jefferson County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -4.2 with a 95% confidence interval from -6.1 to -2.2.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 15.8 with a 95% confidence interval from 11.8 to 20.7 and 11 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.2
Kanawha County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -2.2 with a 95% confidence interval from -3.0 to -1.5.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 14.4 with a 95% confidence interval from 12.4 to 16.7 and 39 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.1
Lewis County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -1.8 with a 95% confidence interval from -3.6 to -0.1.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 21.7 with a 95% confidence interval from 13.8 to 33.0 and 5 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.7
Marion County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -1.4 with a 95% confidence interval from -2.2 to -0.6.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 16.2 with a 95% confidence interval from 12.5 to 20.8 and 14 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.2
Marshall County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -1.5 with a 95% confidence interval from -2.7 to -0.2.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 17.7 with a 95% confidence interval from 12.7 to 24.4 and 9 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.3
Mineral County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -3.2 with a 95% confidence interval from -4.1 to -2.2.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 14.0 with a 95% confidence interval from 9.3 to 20.6 and 6 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.1
Monongalia County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -2.3 with a 95% confidence interval from -3.4 to -1.2.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 12.6 with a 95% confidence interval from 9.6 to 16.1 and 13 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.0
Ohio County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -3.1 with a 95% confidence interval from -4.1 to -2.1.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 14.6 with a 95% confidence interval from 10.4 to 20.1 and 9 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.1
Putnam County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -3.8 with a 95% confidence interval from -5.0 to -2.6.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 11.5 with a 95% confidence interval from 8.3 to 15.6 and 9 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 0.9
Upshur County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -2.4 with a 95% confidence interval from -3.8 to -1.0.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 13.2 with a 95% confidence interval from 8.2 to 20.3 and 5 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.0
Wayne County
- Priority Index(1) : The priority index is 8.
- Recent Trend(2) : The trend is falling because the trend is -2.1 with a 95% confidence interval from -3.4 to -0.8.
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 14.1 with a 95% confidence interval from 10.0 to 19.4 and 9 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.1
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 18.2 with a 95% confidence interval from 10.4 to 30.2 and 4 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.4
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 18.4 with a 95% confidence interval from 11.1 to 30.1 and 4 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.4
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 13.7 with a 95% confidence interval from 8.0 to 22.7 and 4 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.0
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : This death rate is similar compared to the US rate
- Rate : The death rate is 25.2 with a 95% confidence interval from 13.6 to 44.1 and 3 average annual deaths.
- Rate Ratio(3) County to US : The rate ratio is 1.9
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : *
- Rate : *
- Rate Ratio(3) County to US : *
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : *
- Rate : *
- Rate Ratio(3) County to US : *
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : *
- Rate : *
- Rate Ratio(3) County to US : *
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : *
- Rate : *
- Rate Ratio(3) County to US : *
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : *
- Rate : *
- Rate Ratio(3) County to US : *
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : *
- Rate : *
- Rate Ratio(3) County to US : *
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : *
- Rate : *
- Rate Ratio(3) County to US : *
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : *
- Rate : *
- Rate Ratio(3) County to US : *
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : *
- Rate : *
- Rate Ratio(3) County to US : *
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : *
- Rate : *
- Rate Ratio(3) County to US : *
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : *
- Rate : *
- Rate Ratio(3) County to US : *
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : *
- Rate : *
- Rate Ratio(3) County to US : *
- Priority Index(1) : The priority index cannot be determined.
- Recent Trend(2) : **
- County Death Rate Compared to US Rate : *
- Rate : *
- Rate Ratio(3) County to US : *
Notes:
Created by statecancerprofiles.cancer.gov on 04/23/2024 6:16 pm.
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:
Calhoun County, Clay County, Doddridge County, Gilmer County, Grant County, Hardy County, Pendleton County, Pleasants County, Pocahontas County, Ritchie County, Tucker County, Tyler County, Wirt County
Trend for the following could not be reliably determined due to small number of deaths per year:
Roane County, Summers County, Taylor County, Webster County
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.