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