Data Table for Rate/Trend Comparison by Cancer
Death Rate/Trend Comparison by Cancer, 2019-2023
Virginia Counties versus United States
Lung & Bronchus
All Races, Both Sexes
Sorted by rateratio
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 | - | 134,732 | 31.5 (31.4, 31.6) | - | -3.7 (-3.9, -3.5) |
| Virginia | - | falling | - | 3,529 | 32.5 (32.0, 33.0) | - | -3.8 (-4.9, -3.5) |
| Fairfax County | 9 | falling | lower | 200 | 15.7 (14.7, 16.7) | 0.5 | -4.5 (-5.2, -3.8) |
| Arlington County | 9 | falling | lower | 37 | 17.7 (15.3, 20.5) | 0.6 | -4.3 (-5.9, -3.0) |
| Loudoun County | 9 | falling | lower | 68 | 19.1 (17.1, 21.3) | 0.6 | -5.0 (-5.9, -4.1) |
| Albemarle County | 9 | falling | lower | 35 | 20.6 (17.6, 23.9) | 0.7 | -3.7 (-4.7, -2.6) |
| Falls Church City | 7 | stable | lower | 3 | 20.7 (12.0, 33.6) | 0.7 | -2.7 (-5.7, 0.2) |
| Rappahannock County | 6 | stable | similar | 3 | 21.4 (12.1, 38.4) | 0.7 | -2.5 (-6.2, 1.3) |
| Alexandria City | 9 | falling | lower | 32 | 21.5 (18.2, 25.2) | 0.7 | -4.1 (-5.4, -3.0) |
| James City County | 9 | falling | lower | 38 | 24.4 (20.9, 28.3) | 0.8 | -3.4 (-4.3, -2.5) |
| Clarke County | 8 | falling | similar | 7 | 25.7 (17.7, 37.0) | 0.8 | -9.7 (-30.6, -5.6) |
| Goochland County | 8 | falling | similar | 12 | 25.8 (19.5, 34.1) | 0.8 | -3.9 (-6.5, -1.4) |
| Prince William County | 9 | falling | lower | 107 | 26.2 (24.0, 28.6) | 0.8 | -4.0 (-4.6, -3.3) |
| Charlottesville City | 8 | falling | similar | 12 | 26.8 (20.3, 34.9) | 0.9 | -7.4 (-20.8, -4.4) |
| Harrisonburg City | 8 | falling | similar | 11 | 27.7 (20.8, 36.2) | 0.9 | -2.4 (-4.8, -0.2) |
| Montgomery County | 8 | falling | similar | 28 | 27.7 (23.2, 32.8) | 0.9 | -2.3 (-4.0, -0.5) |
| Roanoke County | 8 | falling | similar | 45 | 28.1 (24.5, 32.2) | 0.9 | -2.7 (-3.7, -1.8) |
| Greene County | 8 | falling | similar | 8 | 28.2 (20.2, 38.8) | 0.9 | -3.5 (-6.1, -0.9) |
| Culpeper County | 8 | falling | similar | 20 | 29.6 (23.9, 36.2) | 0.9 | -5.9 (-17.0, -3.5) |
| Manassas City | 8 | falling | similar | 9 | 29.8 (21.2, 40.4) | 0.9 | -2.6 (-4.6, -0.6) |
| Floyd County | 6 | stable | similar | 8 | 29.8 (21.3, 41.6) | 0.9 | -1.7 (-3.6, 0.4) |
| Surry County | 6 | stable | similar | 4 | 30.1 (18.0, 50.5) | 1.0 | -2.8 (-6.3, 0.8) |
| Rockingham County | 8 | falling | similar | 38 | 30.3 (26.0, 35.1) | 1.0 | -2.6 (-3.7, -1.5) |
| Fauquier County | 8 | falling | similar | 30 | 30.8 (26.0, 36.2) | 1.0 | -2.3 (-3.8, -0.8) |
| Chesterfield County | 8 | falling | similar | 133 | 30.8 (28.4, 33.3) | 1.0 | -5.6 (-12.1, -3.4) |
| York County | 8 | falling | similar | 29 | 30.8 (26.0, 36.4) | 1.0 | -3.2 (-4.6, -1.7) |
| Mathews County | 6 | stable | similar | 6 | 30.9 (19.4, 49.2) | 1.0 | -2.5 (-5.6, 0.3) |
| Campbell County | 8 | falling | similar | 28 | 31.2 (26.2, 37.1) | 1.0 | -3.6 (-5.1, -2.2) |
| Cumberland County | 8 | falling | similar | 6 | 31.6 (20.9, 47.4) | 1.0 | -4.3 (-7.3, -1.5) |
| Augusta County | 8 | falling | similar | 41 | 31.7 (27.4, 36.5) | 1.0 | -3.9 (-5.5, -3.0) |
| Fluvanna County | 8 | falling | similar | 13 | 31.8 (24.4, 41.1) | 1.0 | -2.5 (-4.6, -0.3) |
| Stafford County | 8 | falling | similar | 45 | 31.9 (27.7, 36.5) | 1.0 | -5.6 (-9.3, -4.0) |
| Fredericksburg City | 8 | falling | similar | 8 | 32.0 (22.8, 43.6) | 1.0 | -4.0 (-6.9, -1.5) |
| Spotsylvania County | 8 | falling | similar | 52 | 32.0 (28.1, 36.3) | 1.0 | -3.2 (-4.4, -2.0) |
| Rockbridge County | 6 | stable | similar | 14 | 32.1 (24.6, 41.8) | 1.0 | -3.7 (-17.1, 1.2) |
| Suffolk City | 8 | falling | similar | 38 | 32.8 (28.2, 38.0) | 1.0 | -4.0 (-4.9, -3.1) |
| Frederick County | 8 | falling | similar | 44 | 33.5 (29.1, 38.3) | 1.1 | -4.1 (-6.0, -3.2) |
| Hanover County | 8 | falling | similar | 53 | 33.5 (29.5, 37.9) | 1.1 | -3.2 (-4.4, -2.1) |
| Isle of Wight County | 8 | falling | similar | 20 | 33.6 (27.2, 41.3) | 1.1 | -4.1 (-5.4, -2.8) |
| Franklin County | 8 | falling | similar | 33 | 33.7 (28.5, 39.7) | 1.1 | -1.9 (-3.1, -0.6) |
| Carroll County | 8 | falling | similar | 19 | 33.7 (27.3, 41.8) | 1.1 | -3.5 (-6.6, -2.2) |
| Richmond City | 8 | falling | similar | 82 | 34.0 (30.7, 37.6) | 1.1 | -4.1 (-5.0, -3.4) |
| Virginia Beach City | 8 | falling | similar | 183 | 34.0 (31.8, 36.4) | 1.1 | -3.2 (-3.8, -2.6) |
| Madison County | 6 | stable | similar | 8 | 34.1 (24.3, 47.5) | 1.1 | -1.0 (-3.5, 1.8) |
| Appomattox County | 6 | stable | similar | 9 | 34.4 (24.9, 46.9) | 1.1 | -2.4 (-5.5, 0.5) |
| Louisa County | 8 | falling | similar | 22 | 34.4 (27.9, 42.2) | 1.1 | -6.0 (-18.3, -3.8) |
| Chesapeake City | 5 | falling | higher | 95 | 34.7 (31.6, 38.1) | 1.1 | -3.4 (-4.1, -2.7) |
| Bedford City and County | 8 | falling | similar | 48 | 34.9 (30.5, 39.9) | 1.1 | -2.0 (-3.5, -0.4) |
| Henrico County | 5 | falling | higher | 149 | 35.1 (32.6, 37.8) | 1.1 | -2.4 (-2.9, -2.0) |
| Botetourt County | 6 | stable | similar | 21 | 36.0 (29.3, 44.2) | 1.1 | -1.9 (-3.8, 0.1) |
| Radford City | 8 | falling | similar | 5 | 36.2 (22.6, 55.2) | 1.1 | -4.2 (-7.1, -1.9) |
| Newport News City | 5 | falling | higher | 73 | 36.4 (32.7, 40.4) | 1.2 | -6.0 (-13.2, -3.4) |
| Hampton City | 5 | falling | higher | 63 | 36.7 (32.6, 41.1) | 1.2 | -10.8 (-17.3, -3.3) |
| Powhatan County | 8 | falling | similar | 16 | 36.8 (28.9, 46.4) | 1.2 | -3.0 (-4.7, -1.3) |
| Northampton County | 8 | falling | similar | 8 | 37.0 (25.4, 53.2) | 1.2 | -29.2 (-46.3, -6.0) |
| Pittsylvania County | 5 | falling | higher | 39 | 37.2 (32.0, 43.2) | 1.2 | -2.3 (-3.8, -0.9) |
| Nelson County | 6 | stable | similar | 11 | 37.2 (27.6, 50.2) | 1.2 | -2.0 (-4.5, 0.3) |
| Charles City County | 8 | falling | similar | 5 | 38.0 (24.4, 60.0) | 1.2 | -3.1 (-5.8, -0.5) |
| Wythe County | 8 | falling | similar | 17 | 38.1 (30.2, 47.6) | 1.2 | -2.7 (-4.4, -1.1) |
| Orange County | 8 | falling | similar | 22 | 38.4 (31.4, 46.7) | 1.2 | -2.2 (-3.8, -0.6) |
| Essex County | 6 | stable | similar | 7 | 38.5 (26.3, 55.6) | 1.2 | -2.2 (-4.8, 0.3) |
| Russell County | 8 | falling | similar | 18 | 38.7 (31.0, 48.2) | 1.2 | -17.8 (-32.4, -1.9) |
| Poquoson City | 6 | stable | similar | 7 | 38.7 (26.8, 54.8) | 1.2 | -1.9 (-4.2, 0.6) |
| Richmond County | 8 | falling | similar | 6 | 39.0 (26.1, 57.5) | 1.2 | -2.8 (-5.6, -0.2) |
| Shenandoah County | 5 | falling | higher | 28 | 39.3 (33.0, 46.7) | 1.2 | -1.9 (-3.0, -0.9) |
| Northumberland County | 6 | stable | similar | 13 | 39.5 (30.3, 53.1) | 1.3 | -1.6 (-4.8, 1.7) |
| Henry County | 5 | falling | higher | 35 | 39.9 (34.1, 46.8) | 1.3 | -1.7 (-2.9, -0.5) |
| Winchester City | 8 | falling | similar | 15 | 40.1 (31.3, 50.7) | 1.3 | -3.1 (-5.1, -1.4) |
| Accomack County | 5 | falling | higher | 25 | 40.3 (33.4, 48.5) | 1.3 | -3.5 (-10.6, -2.1) |
| Staunton City | 4 | stable | higher | 16 | 40.6 (32.2, 50.9) | 1.3 | -1.4 (-3.0, 0.2) |
| Norfolk City | 5 | falling | higher | 95 | 40.7 (37.0, 44.7) | 1.3 | -2.9 (-3.6, -2.3) |
| Salem City | 4 | stable | higher | 16 | 41.3 (32.5, 52.0) | 1.3 | -1.5 (-3.2, 0.1) |
| Gloucester County | 5 | falling | higher | 25 | 42.3 (35.1, 50.9) | 1.3 | -18.6 (-35.6, -0.4) |
| Dinwiddie County | 5 | falling | higher | 18 | 42.4 (33.8, 52.9) | 1.3 | -2.8 (-4.1, -1.6) |
| King George County | 4 | stable | higher | 13 | 42.7 (32.6, 55.1) | 1.4 | -2.0 (-4.4, 0.7) |
| Caroline County | 5 | falling | higher | 18 | 42.9 (34.2, 53.3) | 1.4 | -3.4 (-5.0, -1.9) |
| Fairfax City | 4 | stable | higher | 11 | 42.9 (32.3, 55.9) | 1.4 | -1.5 (-3.4, 0.3) |
| Portsmouth City | 5 | falling | higher | 48 | 43.0 (37.6, 48.9) | 1.4 | -2.5 (-3.6, -1.5) |
| Southampton County | 5 | falling | higher | 13 | 43.1 (33.1, 55.8) | 1.4 | -2.3 (-3.7, -0.9) |
| Covington City | 6 | stable | similar | 4 | 43.2 (25.7, 70.0) | 1.4 | -0.3 (-3.5, 2.6) |
| Halifax County with South Boston City | 5 | falling | higher | 27 | 43.3 (36.1, 51.8) | 1.4 | -1.6 (-2.9, -0.3) |
| Prince George County | 4 | stable | higher | 19 | 43.5 (35.0, 53.5) | 1.4 | -1.0 (-2.5, 0.8) |
| Pulaski County | 5 | falling | higher | 24 | 43.6 (35.9, 52.7) | 1.4 | -1.9 (-3.6, -0.3) |
| Lynchburg City | 5 | falling | higher | 38 | 44.1 (37.9, 51.0) | 1.4 | -1.9 (-2.8, -1.1) |
| King William County | 5 | falling | higher | 11 | 44.2 (32.8, 58.5) | 1.4 | -3.5 (-6.1, -1.1) |
| Washington County | 5 | falling | higher | 41 | 44.2 (38.1, 51.1) | 1.4 | -2.5 (-3.3, -1.8) |
| Amherst County | 5 | falling | higher | 22 | 44.2 (36.1, 53.8) | 1.4 | -2.4 (-4.1, -0.8) |
| Westmoreland County | 5 | falling | higher | 17 | 45.1 (35.9, 56.7) | 1.4 | -3.3 (-4.9, -1.8) |
| Middlesex County | 5 | falling | higher | 11 | 45.1 (33.0, 62.1) | 1.4 | -2.4 (-4.6, -0.2) |
| Grayson County | 5 | falling | higher | 13 | 45.2 (34.7, 58.7) | 1.4 | -2.3 (-4.0, -0.7) |
| Mecklenburg County | 4 | stable | higher | 27 | 45.2 (37.8, 54.2) | 1.4 | -1.1 (-2.8, 0.6) |
| Danville City | 5 | falling | higher | 30 | 45.3 (38.2, 53.6) | 1.4 | -2.2 (-3.3, -1.2) |
| Brunswick County | 5 | falling | higher | 12 | 45.5 (34.6, 59.5) | 1.4 | -2.3 (-3.9, -0.8) |
| Lunenburg County | 4 | stable | higher | 10 | 46.1 (33.6, 62.7) | 1.5 | -0.9 (-3.5, 1.7) |
| Page County | 4 | stable | higher | 19 | 46.4 (37.5, 57.4) | 1.5 | -0.8 (-2.5, 0.9) |
| King and Queen County | 6 | stable | similar | 6 | 47.0 (30.8, 71.0) | 1.5 | -1.8 (-5.1, 1.4) |
| Tazewell County | 5 | falling | higher | 32 | 47.3 (40.0, 55.8) | 1.5 | -5.5 (-17.0, -1.7) |
| Patrick County | 4 | stable | higher | 16 | 47.3 (37.2, 60.2) | 1.5 | -0.8 (-2.3, 0.8) |
| Martinsville City | 5 | falling | higher | 9 | 47.7 (34.4, 65.0) | 1.5 | -17.3 (-38.8, -2.2) |
| Roanoke City | 5 | falling | higher | 63 | 47.9 (42.6, 53.6) | 1.5 | -2.7 (-13.3, -1.4) |
| Dickenson County | 4 | stable | higher | 12 | 49.0 (36.9, 64.7) | 1.6 | -1.5 (-3.2, 0.3) |
| Buckingham County | 4 | stable | higher | 12 | 49.4 (37.7, 64.2) | 1.6 | -1.3 (-3.0, 0.3) |
| Scott County | 5 | falling | higher | 20 | 49.9 (40.6, 61.4) | 1.6 | -1.6 (-3.1, 0.0) |
| Warren County | 5 | falling | higher | 27 | 50.4 (42.1, 60.0) | 1.6 | -1.6 (-3.0, -0.1) |
| Buchanan County | 5 | falling | higher | 17 | 50.5 (40.1, 63.3) | 1.6 | -1.9 (-3.3, -0.6) |
| Bristol City | 1 | rising | higher | 14 | 51.6 (40.2, 65.8) | 1.6 | 32.2 (12.6, 50.6) |
| Waynesboro City | 4 | stable | higher | 16 | 52.3 (41.2, 65.6) | 1.7 | -0.2 (-1.3, 0.9) |
| Amelia County | 4 | stable | higher | 11 | 52.4 (39.2, 69.4) | 1.7 | -2.1 (-4.4, 0.3) |
| Greensville County | 4 | stable | higher | 7 | 52.5 (36.7, 73.6) | 1.7 | -0.7 (-3.5, 2.1) |
| Franklin City | 4 | stable | higher | 6 | 52.9 (35.9, 76.2) | 1.7 | 26.1 (-3.5, 54.2) |
| Alleghany County and Clifton Forge City | 4 | stable | higher | 15 | 53.2 (41.6, 68.1) | 1.7 | -0.2 (-2.3, 2.0) |
| Colonial Heights City | 5 | falling | higher | 15 | 53.8 (42.2, 68.1) | 1.7 | -1.6 (-3.0, -0.2) |
| Giles County | 5 | falling | higher | 15 | 54.1 (42.6, 68.6) | 1.7 | -1.6 (-3.0, -0.2) |
| New Kent County | 4 | stable | higher | 16 | 54.2 (42.3, 68.5) | 1.7 | -1.8 (-3.9, 0.6) |
| Nottoway County | 4 | stable | higher | 12 | 54.6 (41.4, 71.1) | 1.7 | -2.1 (-5.2, 0.6) |
| Prince Edward County | 4 | stable | higher | 14 | 54.9 (42.5, 70.0) | 1.7 | -0.1 (-2.0, 1.8) |
| Sussex County | 5 | falling | higher | 9 | 55.9 (40.0, 76.8) | 1.8 | -19.8 (-35.9, -2.3) |
| Smyth County | 5 | falling | higher | 30 | 59.2 (50.1, 69.9) | 1.9 | -1.4 (-2.5, -0.4) |
| Petersburg City | 5 | falling | higher | 26 | 60.0 (49.8, 71.8) | 1.9 | -1.8 (-3.1, -0.5) |
| Galax City | 4 | stable | higher | 5 | 60.3 (39.5, 89.2) | 1.9 | 11.0 (-12.0, 31.3) |
| Charlotte County | 4 | stable | higher | 12 | 61.2 (46.5, 80.2) | 1.9 | 2.4 (-2.1, 18.5) |
| Lancaster County | 4 | stable | higher | 15 | 61.7 (45.8, 82.9) | 2.0 | 0.0 (-3.0, 3.0) |
| Hopewell City | 4 | stable | higher | 17 | 62.5 (49.6, 77.9) | 2.0 | 14.4 (-3.2, 29.0) |
| Lee County | 4 | stable | higher | 24 | 63.3 (52.2, 76.6) | 2.0 | -1.5 (-3.4, 0.2) |
| Wise County | 5 | falling | higher | 34 | 65.7 (55.9, 76.8) | 2.1 | -1.3 (-2.5, -0.2) |
| Bath County |
|
** | similar | 4 | 49.6 (30.6, 81.8) | 1.6 |
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| Bland County |
|
** | similar | 3 | 31.1 (17.8, 53.6) | 1.0 |
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| Buena Vista City |
|
** | similar | 5 | 47.6 (30.1, 73.1) | 1.5 |
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| Emporia City |
|
** | similar | 4 | 54.1 (33.5, 84.0) | 1.7 |
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| Williamsburg City |
|
** | similar | 6 | 32.5 (21.8, 47.7) | 1.0 |
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| Craig County |
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** |
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| Highland County |
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** |
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| Lexington City |
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** |
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| Manassas Park City |
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** |
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| Norton City |
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** |
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Notes:
Created by statecancerprofiles.cancer.gov on 03/12/2026 2:41 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. 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 (20 age groups: <1, 1-4, 5-9, ... , 80-84, 85-89, 90+). The Healthy People 2030 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:
Craig County, Highland County, Lexington City, Manassas Park City, Norton City
Trend for the following could not be reliably determined due to small number of deaths per year:
Bath County, Bland County, Buena Vista City, Emporia City, Williamsburg 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 do not include Puerto Rico.
Created by statecancerprofiles.cancer.gov on 03/12/2026 2:41 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 > 1.10Similar
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. 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 (20 age groups: <1, 1-4, 5-9, ... , 80-84, 85-89, 90+). The Healthy People 2030 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:
Craig County, Highland County, Lexington City, Manassas Park City, Norton City
Trend for the following could not be reliably determined due to small number of deaths per year:
Bath County, Bland County, Buena Vista City, Emporia City, Williamsburg 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 do not include Puerto Rico.