ESTIMATED PREVALENCE AND INCIDENCE OF LUNG DISEASE BY LUNG ASSOCIATION TERRITORY

Transcription

1 ESTIMATED PREVALENCE AND INCIDENCE OF LUNG DISEASE BY LUNG ASSOCIATION TERRITORY AMERICAN LUNG ASSOCIATION EPIDEMIOLOGY AND STATISTICS UNIT RESEARCH AND PROGRAM SERVICES April 2007

2 EXECUTIVE SUMMARY Estimated Prevalence and Incidence of Lung Disease by Lung Association Territory has been compiled to provide Lung Associations with lung disease morbidity data pertinent to the areas they serve. This document displays prevalence estimates of asthma, chronic bronchitis and emphysema as well as the incidence of lung cancer at the state, county and constituent levels. Data are based upon the 2005 National Health Interview Survey, the 2005 Behavioral Risk Factor Surveillance Survey, CDC Wonder and the 2003 joint report from CDC s National Program of Cancer Registries, NCI s SEER program and state-based cancer registries. Prior to 2001, this publication also showed estimates for acute lung diseases. Due to the revision of the National Health Interview Survey s questionnaire in 1997, questions on acute lung diseases were eliminated. Therefore, the most recent acute lung disease estimates by lung association territory are in the April 2000 Estimated Prevalence and Incidence of Lung Disease by Lung Association Territory. Questions on chronic lung disease were revised as well. Chronic bronchitis and emphysema prevalence estimates are still obtained from the National Health Interview Survey (NHIS) but current estimates cannot be compared to those found in versions of the Estimated Prevalence and Incidence of Lung Disease by Lung Association Territory prior to Adult asthma prevalence estimates are taken from the Behavioral Risk Factor Surveillance Survey (BRFSS), a state-based, random-digit-dialed survey of the non-institutionalized U.S. adult population. The BRFSS has been collecting data on asthma prevalence since 2000 and these estimates have been used in this publication since April Pediatric asthma prevalence estimates are based on agespecific national prevalence rates from the 2005 NHIS applied to age-specific county population estimates from the US Census. Lung cancer incidence estimates are obtained from CDC Wonder, a state by state database, and a report from the two federal programs that support population-based cancer registries in the U.S. The report delineates the age-adjusted incidence rates for lung cancer during Information from this joint report covers approximately 96% of the U.S. population. For those states not included in the report (3), a call was made to the individual state-cancer registries and the latest incidence counts and age-adjusted rates were collected and used. Please note that these numbers reflect the estimated prevalence and incidence of lung disease within each Lung Association area, and not the actual number. That is, the estimate is derived from national and/or state data and adjusted for the age-specific population of each area. Many other factors may affect actual prevalence. When releasing this information to the public or press, make efforts to ensure that the nature and derivation of these estimates are understood. April 2007

3 STATISTICAL METHODOLOGY Presently, county-specific measurements of the number of persons with chronic lung disease are not available. In order to assess the magnitude of lung disease at the county levels, we have utilized a synthetic estimation technique originally developed by the U.S. Bureau of the Census. This method uses age-specific national or state estimates of diagnosed lung disease to project the prevalence of chronic lung disease and sex-specific age-adjusted state estimates to project the incidence of lung cancer within the counties served by Lung Association constituents. Table 1 summarizes these prevalence and incidence estimates. Prevalence Estimates: Chronic Bronchitis and Emphysema. This is the eighth year that the revised National Health Interview Survey questionnaire has been utilized. Prior to 1997, survey respondents were asked Have you or someone in your family had chronic bronchitis or emphysema in the past year? After 1997, the chronic bronchitis question states, Have you been diagnosed with chronic bronchitis by a health professional in the past year? while the emphysema question asks respondents, Have you been diagnosed with emphysema by a health professional during your lifetime? Revisions to these questions included a change in prevalence time frames (ending overall COPD estimates) and the elimination of childhood estimates. This year s publication utilized the 2005 National Health Interview Survey. It was estimated that 8.9 million Americans had a diagnosis of chronic bronchitis and 3.8 million Americans had emphysema. Local area prevalence of chronic bronchitis and emphysema are estimated by applying age-specific national prevalence rates from the 2005 NHIS to age-specific county-level resident populations for Thereafter, the age-specific prevalence estimates for each county within a Lung Association area are summed to determine its overall prevalence. Prevalence estimates for chronic bronchitis and emphysema are calculated for those 18-44, 45 to 64 and 65 plus. An individual respondent to the NHIS can report the presence of more than one chronic lung disease, i.e. chronic bronchitis and emphysema. For this reason and the fact that prevalence estimates are over different time frames (chronic bronchitis prevalence over a year vs. emphysema over a lifetime), adding these estimates to calculate COPD prevalence should not be performed, as it would overestimate the prevalence in your community. Adult Asthma. This is the sixth year that the Behavioral Risk Factor Surveillance Survey has been used. It was assumed that state-specific figures would be a better measure of county prevalence than national estimates from the National Health Interview Survey. The Behavioral Risk Factor Surveillance Survey questionnaire asks respondents Have you ever been diagnosed with asthma by a health professional? and Do you still have asthma? Data results from the latter question are used to obtain county estimates. In 2005, the Behavioral Risk Factor Surveillance System (BRFSS) survey indicated that approximately 8.0% of adults residing in the United States reported having asthma.

4 Local area prevalence of adult asthma is estimated by applying age-specific state prevalence rates from the 2005 BRFSS to age-specific county-level resident populations obtained from the U.S. Bureau of the Census web site. Thereafter, the age-specific prevalence estimates for each county within a Lung Association area are summed to determine its overall prevalence. The prevalence estimate for adult asthma is calculated for those 18 years of age and over. Pediatric Asthma. Local area prevalence of pediatric asthma is estimated by applying age-specific state prevalence rates from the 2005 NHIS to age-specific county-level resident populations obtained from the U.S. Census Bureau web site. Thereafter, the age-specific prevalence estimates for each county within a Lung Association area are summed to determine its overall prevalence. The prevalence estimate for pediatric asthma is calculated for those under 18 years of age. Incidence Estimates: Lung Cancer. In 2007 the U.S. Cancer Statistics Working Group published its fifth joint report displaying 2003 state specific lung cancer incidence estimates from both the NCI s Surveillance, Epidemiology and End Results (SEER) program and the CDC s National Program of Cancer Registries. SEER statistics are derived from 18 regional registries. Information from this joint report covers approximately 96% of the U.S. population. Data from an additional 3 states not included in this report or CDC Wonder were obtained from individual cancer registries. Caution should be used when comparing estimates from the majority of states with Arizona, Tennessee and Wyoming as State Cancer Registries provided their incidence rates. All incidence rates are from Local area incidence of lung cancer is estimated by applying 2003 age-adjusted incidence rates to county populations in 2003 obtained from the U.S. Census Bureau. Thereafter, the age-adjusted incidence estimates for each county within a Lung Association area are summed to determine its overall incidence. The incidence estimate for lung cancer is for all ages. The standard used to age-adjust the rates for this report was the 2000 U.S. standard population. Rates are per 100,000 population. Lung cancer incidence estimates cannot be compared with versions prior to the 2003 Estimated Prevalence and Incidence of Lung Disease by Lung Association Territory. Limitations of Estimates Since the statistics presented by the NHIS and BRFSS are based on a sample, they will differ (due to random sampling variability) from figures that would be derived from a complete census or case registry of people in the U.S. with these diseases. The results are also subject to reporting, non-response and processing errors. These types of errors are kept to a minimum by methods built into the survey. Additionally, a major limitation of both surveys is that the information collected represents self-reports of medically diagnosed conditions, which may underestimate disease prevalence since not all individuals with these conditions have been properly diagnosed. However, the NHIS is the best available source that depicts the magnitude of chronic lung disease on the national level, while the BRFSS is the best available source for adult asthma information on the state level. The conditions covered in the surveys may vary considerably in the accuracy and completeness with which they are reported.

5 Local estimates of chronic lung diseases are scaled in direct proportion to the base population of the county and its age distribution. No adjustments are made for other factors that may affect local prevalence (e.g. local prevalence of cigarette smokers or occupational exposures) since the health surveys that obtain such data are rarely conducted on the county level. Because the estimates do not account for geographic differences in the prevalence of chronic and acute diseases, the sum of the estimates for each of the counties in the United States may not exactly reflect the national estimate derived by the NHIS or state estimates derived by the BRFSS. Sources: 1. Irwin, R. Guide to Local Area Populations U.S. Bureau of the Census Technical Paper Number 39 (1972). 2. National Center for Health Statistics. Raw Data from the National Health Interview Survey, United States, Calculations by the American Lung Association Research and Program Services Division using SPSS and SUDAAN software. 3. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System, U.S. Cancer Statistics Working Group. U.S. Cancer Statistics: 2003 Incidence. 5. State-Cancer Registries of AZ, TN, WY. 6. U.S. Census Bureau, American Fact Finder, U.S. Census 2005, July 1, Note: States are organized by associations who have merged or plan to merge by July 1, 2007.

6 TABLE 1: ESTIMATED PREVALENCE AND INCIDENCE OF LUNG DISEASE BY COUNTY, STATE AND LUNG ASSOCIATION, Total Pediatric Adult Chronic ALABAMA CONSTITUENT 4,557,808 96, , ,339 63,292 3,442 ALA OF ALABAMA Autauga County 48,612 1,118 2,580 1, Baldwin County 162,586 3,241 8,942 5,303 2, Barbour County 28, , Bibb County 21, , Blount County 55,725 1,167 3,033 1, Bullock County 11, Butler County 20, , Calhoun County 112,141 2,261 6,181 3,613 1, Chambers County 35, ,926 1, Cherokee County 24, , Chilton County 41, ,260 1, Choctaw County 14, Clarke County 27, , Clay County 13, Cleburne County 14, Coffee County 45, ,490 1, Colbert County 54,660 1,064 3,041 1, Conecuh County 13, Coosa County 11, Covington County 37, ,036 1, Crenshaw County 13, Cullman County 79,886 1,614 4,386 2,571 1, Dale County 48,748 1,142 2,562 1, Dallas County 44,366 1,088 2,293 1, DeKalb County 67,271 1,439 3,634 2, Elmore County 73,937 1,573 4,014 2, Escambia County 38, ,088 1, Etowah County 103,189 2,101 5,658 3,349 1, Fayette County 18, , Franklin County 30, , Geneva County 25, , Greene County 9, Hale County 18, Henry County 16, Houston County 94,249 2,079 5,055 2,958 1, Jackson County 53,650 1,085 2,962 1, Jefferson County 657,229 13,969 35,690 20,749 9, Lamar County 14, Lauderdale County 87,691 1,661 4,899 2,894 1, Lawrence County 34, ,895 1, Lee County 123,254 2,336 6,860 3,738 1, Limestone County 70,469 1,445 3,875 2, Lowndes County 13, Macon County 22, , Madison County 298,192 6,344 16,214 9,304 3, Marengo County 21, , Marion County 30, ,685 1, Marshall County 85,634 1,880 4,589 2,678 1, Mobile County 401,427 9,368 21,164 12,215 5, Monroe County 23, , Montgomery County 221,619 5,017 11,784 6,752 2, Morgan County 113,740 2,419 6,189 3,595 1, Perry County 11, Pickens County 20, , Pike County 29, , Randolph County 22, , Russell County 49,326 1,104 2,633 1, St. Clair County 72,330 1,498 3,964 2, Shelby County 171,465 3,839 9,244 5,169 1, Sumter County 13, Talladega County 80,457 1,697 4,384 2,551 1, Tallapoosa County 40, ,242 1, Tuscaloosa County 168,908 3,369 9,317 5,256 2, Walker County 70,117 1,400 3,870 2,283 1, Washington County 17, Wilcox County 12, Winston County 24, ,

7 ARKANSAS CONSTITUENT 2,779,154 60, ,926 87,099 39,167 2,204 ALA OF ARKANSAS Arkansas County 20, , Ashley County 23, , Baxter County 40, ,451 1, Benton County 186,938 4,336 10,300 5,627 2, Boone County 35, ,066 1, Bradley County 12, Calhoun County 5, Carroll County 26, , Chicot County 13, Clark County 22, , Clay County 16, Cleburne County 25, , Cleveland County 8, Columbia County 24, , Conway County 20, , Craighead County 86,735 1,846 4,922 2,666 1, Crawford County 57,630 1,329 3,192 1, Crittenden County 51,882 1,384 2,719 1, Cross County 19, , Dallas County 8, Desha County 14, Drew County 18, , Faulkner County 97,147 2,056 5,523 2,922 1, Franklin County 18, , Fulton County 11, Garland County 93,551 1,748 5,490 3,179 1, Grant County 17, , Greene County 39, ,224 1, Hempstead County 23, , Hot Spring County 31, ,793 1, Howard County 14, Independence County 34, ,997 1, Izard County 13, Jackson County 17, , Jefferson County 81,700 1,822 4,574 2,532 1, Johnson County 24, , Lafayette County 8, Lawrence County 17, Lee County 11, Lincoln County 14, Little River County 13, Logan County 22, , Lonoke County 60,658 1,389 3,369 1, Madison County 14, Marion County 16, , Miller County 43, ,421 1, Mississippi County 47,911 1,236 2,542 1, Monroe County 9, Montgomery County 9, Nevada County 9, Newton County 8, Ouachita County 27, , Perry County 10, Phillips County 24, , Pike County 11, Poinsett County 25, , Polk County 20, , Pope County 56,580 1,186 3,225 1, Prairie County 9, Pulaski County 366,463 8,211 20,507 11,287 4, Randolph County 18, , St. Francis County 27, , Saline County 91,188 1,881 5,233 2,894 1, Scott County 11, Searcy County 7, Sebastian County 118,750 2,718 6,590 3,649 1, Sevier County 16, Sharp County 17, , Stone County 11, Union County 44, ,498 1, Van Buren County 16, Washington County 180,357 4,042 10,068 5,327 1, White County 71,332 1,466 4,087 2, Woodruff County 8, Yell County 21, ,

8 ALA OF CALIFORNIA 36,132, ,466 1,909,301 1,068, ,177 19,162 Alameda County 1,448,905 32,313 78,658 44,174 17, Alpine County 1, Amador County 38, ,307 1, Butte County 214,185 4,244 12,060 6,851 3, Calaveras County 46, ,766 1, Colusa County 21, , Contra Costa County 1,017,787 23,464 54,874 31,174 13, Del Norte County 28, , El Dorado County 176,841 3,620 9,947 5,690 2, Fresno County 877,584 24,105 43,682 24,239 9, Glenn County 27, , Humboldt County 128,376 2,449 7,324 4,149 1, Imperial County 155,823 4,201 7,813 4,335 1, Inyo County 18, , Kern County 756,825 20,680 37,686 20,780 7, Kings County 143,420 3,597 7,337 3,951 1, Lake County 65,147 1,327 3,676 2,136 1, Lassen County 34, ,013 1, Los Angeles County 9,935, , , , ,234 5,331 Madera County 142,788 3,594 7,376 4,105 1, Marin County 246,960 4,479 14,463 8,435 3, Mariposa County 18, , Mendocino County 88,161 1,859 4,925 2,846 1, Merced County 241,706 7,044 11,676 6,437 2, Modoc County 9, Mono County 12, Monterey County 412,104 10,462 21,222 11,791 4, Napa County 132,764 2,768 7,405 4,249 1, Nevada County 98,394 1,746 5,797 3,404 1, Orange County 2,988,072 71, ,985 88,492 35,849 1,597 Placer County 317,028 6,545 17,684 10,074 4, Plumas County 21, , Riverside County 1,946,419 49, ,091 55,726 22, Sacramento County 1,363,482 33,245 71,513 40,041 16, San Benito County 55,936 1,534 2,796 1, San Bernardino County 1,963,535 53,857 97,597 53,654 19,657 1,004 San Diego County 2,933,462 67, ,702 87,417 35,427 1,583 San Francisco County 739,426 9,745 45,518 25,638 11, San Joaquin County 664,116 17,557 33,628 18,670 7, San Luis Obispo County 255,478 4,544 14,838 8,438 3, San Mateo County 699,610 14,676 38,955 22,259 9, Santa Barbara County 400,762 8,837 21,786 12,265 5, Santa Clara County 1,699,052 38,119 91,888 51,418 20, Santa Cruz County 249,666 5,127 13,956 7,871 3, Shasta County 179,904 3,772 10,034 5,787 2, Sierra County 3, Siskiyou County 45, ,622 1, Solano County 411,593 10,147 21,560 12,116 4, Sonoma County 466,477 9,830 25,969 14,856 6, Stanislaus County 505,505 13,432 25,566 14,234 5, Sutter County 88,876 2,161 4,672 2,632 1, Tehama County 61,197 1,380 3,324 1, Trinity County 13, Tulare County 410,874 11,957 19,900 11,028 4, Tuolumne County 59, ,566 2,068 1, Ventura County 796,106 19,497 41,865 23,620 9, Yolo County 184,932 3,960 10,056 5,503 2, Yuba County 67,153 1,818 3,362 1, ALA OF THE CENTRAL STATES (KANSAS MISSOURI, NEBRASKA, OKLAHOMA AND TEXAS) 36,711, ,075 1,974,941 1,097, ,513 26,062 KANSAS 2,744,687 60, ,195 85,148 37,245 1,907 Allen County 13, Anderson County 8, Atchison County 16, Barber County 4, Barton County 28, , Bourbon County 14, Brown County 10, Butler County 62,354 1,377 3,255 1, Chase County 3,

9 KANSAS cont'd Chautauqua County 4, Cherokee County 21, , Cheyenne County 2, Clark County 2, Clay County 8, Cloud County 9, Coffey County 8, Comanche County 1, Cowley County 35, ,840 1, Crawford County 38, ,061 1, Decatur County 3, Dickinson County 19, , Doniphan County 7, Douglas County 102,914 1,654 5,877 3,199 1, Edwards County 3, Elk County 3, Ellis County 26, , Ellsworth County 6, Finney County 38,988 1,150 1,830 1, Ford County 33, , Franklin County 26, , Geary County 24, , Gove County 2, Graham County 2, Grant County 7, Gray County 5, Greeley County 1, Greenwood County 7, Hamilton County 2, Harper County 6, Harvey County 33, ,767 1, Haskell County 4, Hodgeman County 2, Jackson County 13, Jefferson County 19, , Jewell County 3, Johnson County 506,562 11,346 26,512 15,409 6, Kearny County 4, Kingman County 8, Kiowa County 2, Labette County 22, , Lane County 1, Leavenworth County 73,113 1,588 3,863 2, Lincoln County 3, Linn County 9, Logan County 2, Lyon County 35, ,887 1, McPherson County 29, , Marion County 12, Marshall County 10, Meade County 4, Miami County 30, , Mitchell County 6, Montgomery County 34, ,821 1, Morris County 6, Morton County 3, Nemaha County 10, Neosho County 16, Ness County 3, Norton County 5, Osage County 17, Osborne County 4, Ottawa County 6, Pawnee County 6, Phillips County 5, Pottawatomie County 19, Pratt County 9, Rawlins County 2, Reno County 63,558 1,275 3,372 2,076 1, Republic County 5, Rice County 10, Riley County 62, ,590 1, Rooks County 5, Rush County 3,

10 KANSAS cont'd Russell County 6, Saline County 53,919 1,169 2,812 1, Scott County 4, Sedgwick County 466,061 11,169 23,672 13,891 5, Seward County 23, , Shawnee County 172,365 3,686 9,050 5,461 2, Sheridan County 2, Sherman County 6, Smith County 4, Stafford County 4, Stanton County 2, Stevens County 5, Sumner County 24, , Thomas County 7, Trego County 3, Wabaunsee County 6, Wallace County 1, Washington County 6, Wichita County 2, Wilson County 9, Woodson County 3, Wyandotte County 155,750 3,863 7,818 4,558 1, NEBRASKA 1,758,787 38,415 88,937 54,677 24,130 1,126 Adams County 33, ,716 1, Antelope County 7, Arthur County Banner County Blaine County Boone County 5, Box Butte County 11, Boyd County 2, Brown County 3, Buffalo County 43, ,256 1, Burt County 7, Butler County 8, Cass County 25, , Cedar County 9, Chase County 3, Cherry County 6, Cheyenne County 9, Clay County 6, Colfax County 10, Cuming County 9, Custer County 11, Dakota County 20, Dawes County 8, Dawson County 24, , Deuel County 2, Dixon County 6, Dodge County 36, ,853 1, Douglas County 486,929 11,191 24,269 14,611 5, Dundy County 2, Fillmore County 6, Franklin County 3, Frontier County 2, Furnas County 5, Gage County 23, , Garden County 1, Garfield County 1, Gosper County 2, Grant County Greeley County 2, Hall County 55,104 1,302 2,710 1, Hamilton County 9, Harlan County 3, Hayes County 1, Hitchcock County 2, Holt County 10, Hooker County Howard County 6, Jefferson County 7, Johnson County 4, Kearney County 6, Keith County 8, Keya Paha County Kimball County 3, Knox County 8, Lancaster County 264,814 5,334 13,777 8,151 3,

11 NEBRASKA cont'd Lincoln County 35, ,808 1, Logan County Loup County McPherson County Madison County 35, ,774 1, Merrick County 8, Morrill County 5, Nance County 3, Nemaha County 6, Nuckolls County 4, Otoe County 15, Pawnee County 2, Perkins County 3, Phelps County 9, Pierce County 7, Platte County 31, , Polk County 5, Red Willow County 11, Richardson County 8, Rock County 1, Saline County 14, Sarpy County 139,371 3,479 6,759 3,949 1, Saunders County 20, , Scotts Bluff County 36, ,855 1, Seward County 16, Sheridan County 5, Sherman County 3, Sioux County 1, Stanton County 6, Thayer County 5, Thomas County Thurston County 7, Valley County 4, Washington County 19, , Wayne County 9, Webster County 3, Wheeler County York County 14, MISSOURI 5,800, , , ,618 80,666 4,700 Adair County 24, , Andrew County 16, , Atchison County 6, Audrain County 25, , Barry County 35, ,367 1, Barton County 13, Bates County 17, , Benton County 18, , Bollinger County 12, Boone County 143,326 2,726 10,268 4,388 1, Buchanan County 84,904 1,731 5,814 2,703 1, Butler County 41, ,806 1, Caldwell County 9, Callaway County 42, ,934 1, Camden County 39, ,767 1, Cape Girardeau County 71,161 1,370 4,972 2,285 1, Carroll County 10, Carter County 5, Cass County 94,232 2,127 6,273 2,882 1, Cedar County 14, Chariton County 8, Christian County 67,266 1,475 4,556 2, Clark County 7, Clay County 202,078 4,455 13,610 6,181 2, Clinton County 20, , Cole County 72,757 1,472 5,024 2, Cooper County 17, , Crawford County 23, , Dade County 7, Dallas County 16, , Daviess County 8, DeKalb County 12, Dent County 15, , Douglas County 13, Dunklin County 32, ,139 1, Franklin County 99,090 2,172 6,644 3,079 1, Gasconade County 15, , Gentry County 6,

12 MISSOURI cont'd Greene County 250,784 4,721 17,660 8,066 3, Grundy County 10, Harrison County 8, Henry County 22, , Hickory County 9, Holt County 5, Howard County 9, Howell County 38, ,572 1, Iron County 10, Jackson County 662,959 14,891 44,133 20,389 8, Jasper County 110,624 2,475 7,378 3,397 1, Jefferson County 213,669 4,744 14,362 6,520 2, Johnson County 50,784 1,048 3,548 1, Knox County 4, Laclede County 34, ,310 1, Lafayette County 33, ,235 1, Lawrence County 37, ,451 1, Lewis County 10, Lincoln County 47,727 1,103 3,182 1, Linn County 13, Livingston County 14, McDonald County 22, , Macon County 15, , Madison County 12, Maries County 8, Marion County 28, , Mercer County 3, Miller County 24, , Mississippi County 13, Moniteau County 15, , Monroe County 9, Montgomery County 12, Morgan County 20, , New Madrid County 18, , Newton County 55,554 1,198 3,725 1, Nodaway County 21, , Oregon County 10, Osage County 13, Ozark County 9, Pemiscot County 19, , Perry County 18, , Pettis County 40, ,660 1, Phelps County 42, ,954 1, Pike County 18, , Platte County 82,085 1,717 5,619 2,559 1, Polk County 28, , Pulaski County 44, ,028 1, Putnam County 5, Ralls County 9, Randolph County 25, , Ray County 24, , Reynolds County 6, Ripley County 13, St. Charles County 329,940 7,578 21,991 9,875 3, St. Clair County 9, Ste. Genevieve County 18, , St. Francois County 61,661 1,169 4,332 1, St. Louis County 1,004,666 20,840 67,959 32,380 14, Saline County 23, , Schuyler County 4, Scotland County 4, Scott County 41, ,710 1, Shannon County 8, Shelby County 6, Stoddard County 29, , Stone County 30, ,148 1, Sullivan County 6, Taney County 42, ,961 1, Texas County 24, , Vernon County 20, , Warren County 28, , Washington County 24, , Wayne County 13, Webster County 34, ,292 1, Worth County 2, Wright County 18, , St. Louis city 344,362 7,723 23,019 10,501 4,

13 OKLAHOMA 3,547,884 75, , ,049 48,852 2,943 Adair County 21, , Alfalfa County 5, Atoka County 14, Beaver County 5, Beckham County 18, , Blaine County 12, Bryan County 37, ,471 1, Caddo County 30, , Canadian County 98,701 2,100 6,359 3,063 1, Carter County 47,125 1,012 3,040 1, Cherokee County 44, ,889 1, Choctaw County 15, Cimarron County 2, Cleveland County 224,898 4,321 14,916 6,997 2, Coal County 5, Comanche County 112,429 2,774 6,885 3,250 1, Cotton County 6, Craig County 15, Creek County 68,708 1,483 4,420 2,184 1, Custer County 25, , Delaware County 39, ,596 1, Dewey County 4, Ellis County 3, Garfield County 56,958 1,227 3,672 1, Garvin County 27, , Grady County 49,369 1,044 3,192 1, Grant County 4, Greer County 5, Harmon County 3, Harper County 3, Haskell County 12, Hughes County 13, Jackson County 26, , Jefferson County 6, Johnston County 10, Kay County 46,480 1,026 2,975 1, Kingfisher County 14, Kiowa County 9, Latimer County 10, Le Flore County 49,528 1,081 3,174 1, Lincoln County 32, ,080 1, Logan County 36, ,436 1, Love County 9, McClain County 30, , McCurtain County 33, ,134 1, McIntosh County 19, , Major County 7, Marshall County 14, Mayes County 39, ,548 1, Murray County 12, Muskogee County 70,607 1,500 4,568 2,242 1, Noble County 11, Nowata County 10, Okfuskee County 11, Oklahoma County 684,543 15,275 43,502 20,943 8, Okmulgee County 39, ,552 1, Osage County 45, ,996 1, Ottawa County 32, ,134 1, Pawnee County 16, , Payne County 69,151 1,056 4,850 2, Pittsburg County 44, ,991 1, Pontotoc County 35, ,307 1, Pottawatomie County 68,272 1,429 4,432 2, Pushmataha County 11, Roger Mills County 3, Rogers County 80,757 1,762 5,169 2,509 1, Seminole County 24, , Sequoyah County 40, ,613 1, Stephens County 42, ,836 1, Texas County 20, , Tillman County 8, Tulsa County 572,059 12,940 36,184 17,512 7, Wagoner County 64,183 1,395 4,107 1, Washington County 49, ,249 1, Washita County 11, Woods County 8, Woodward County 19, ,

14 TEXAS 22,859, ,039 1,121, , ,621 15,387 Anderson County 56,408 1,015 3,034 1, Andrews County 12, Angelina County 81,557 1,973 4,082 2,448 1, Aransas County 24, , Archer County 9, Armstrong County 2, Atascosa County 43,226 1,113 2,093 1, Austin County 26, , Bailey County 6, Bandera County 19, , Bastrop County 69,932 1,628 3,515 2, Baylor County 3, Bee County 32, ,731 1, Bell County 256,057 7,158 11,803 6,923 2, Bexar County 1,518,370 37,692 74,270 43,988 17,549 1,024 Blanco County 9, Borden County Bosque County 18, Bowie County 90,643 1,935 4,734 2,840 1, Brazoria County 278,484 6,809 13,689 8,104 3, Brazos County 156,305 2,941 8,053 4,582 1, Brewster County 9, Briscoe County 1, Brooks County 7, Brown County 38, ,020 1, Burleson County 17, Burnet County 41, ,276 1, Caldwell County 36, ,823 1, Calhoun County 20, , Callahan County 13, Cameron County 378,311 11,424 16,954 10,037 4, Camp County 12, Carson County 6, Cass County 30, , Castro County 7, Chambers County 28, , Cherokee County 48,464 1,131 2,462 1, Childress County 7, Clay County 11, Cochran County 3, Coke County 3, Coleman County 8, Collin County 659,457 16,178 31,965 18,683 6, Collingsworth County 2, Colorado County 20, , Comal County 96,018 2,031 5,047 3,038 1, Comanche County 13, Concho County 3, Cooke County 38, ,990 1, Coryell County 75,802 1,734 3,687 2, Cottle County 1, Crane County 3, Crockett County 3, Crosby County 6, Culberson County 2, Dallam County 6, Dallas County 2,305,454 58, ,979 65,235 23,942 1,589 Dawson County 14, Deaf Smith County 18, Delta County 5, Denton County 554,642 13,289 26,950 15,647 4, DeWitt County 20, , Dickens County 2, Dimmit County 10, Donley County 3, Duval County 12, Eastland County 18, Ector County 125,339 3,312 6,022 3,593 1, Edwards County 1, Ellis County 133,474 3,271 6,559 3,885 1, El Paso County 721,598 20,155 33,618 19,927 8, Erath County 34, ,777 1, Falls County 17, Fannin County 33, ,787 1, Fayette County 22, , Fisher County 4, Floyd County 7,

15 TEXAS cont'd Foard County 1, Fort Bend County 463,650 11,384 22,636 13,337 4, Franklin County 10, Freestone County 18, , Frio County 16, Gaines County 14, Galveston County 277,563 6,353 14,123 8,449 3, Garza County 5, Gillespie County 23, , Glasscock County 1, Goliad County 7, Gonzales County 19, Gray County 21, , Grayson County 116,834 2,542 6,100 3,679 1, Gregg County 115,649 2,737 5,840 3,507 1, Grimes County 25, , Guadalupe County 103,032 2,349 5,238 3,126 1, Hale County 36, ,736 1, Hall County 3, Hamilton County 8, Hansford County 5, Hardeman County 4, Hardin County 50,976 1,136 2,630 1, Harris County 3,693,050 94, , ,332 37,811 2,502 Harrison County 63,459 1,421 3,276 1, Hartley County 5, Haskell County 5, Hays County 124,432 2,535 6,377 3,699 1, Hemphill County 3, Henderson County 80,017 1,663 4,270 2,593 1, Hidalgo County 678,275 21,265 29,523 17,311 6, Hill County 35, ,852 1, Hockley County 22, , Hood County 47, ,614 1, Hopkins County 33, ,730 1, Houston County 23, , Howard County 32, ,711 1, Hudspeth County 3, Hunt County 82,543 1,847 4,231 2,529 1, Hutchinson County 22, , Irion County 1, Jack County 9, Jackson County 14, Jasper County 35, ,844 1, Jeff Davis County 2, Jefferson County 247,571 5,543 12,734 7,639 3, Jim Hogg County 5, Jim Wells County 40,951 1,048 1,999 1, Johnson County 146,376 3,436 7,325 4,349 1, Jones County 19, , Karnes County 15, Kaufman County 89,129 2,110 4,440 2,631 1, Kendall County 28, , Kenedy County Kent County Kerr County 46, ,582 1, Kimble County 4, King County Kinney County 3, Kleberg County 30, , Knox County 3, Lamar County 49,644 1,121 2,569 1, Lamb County 14, Lampasas County 19, , La Salle County 6, Lavaca County 18, , Lee County 16, Leon County 16, Liberty County 75,141 1,753 3,769 2, Limestone County 22, , Lipscomb County 3, Live Oak County 11, Llano County 18, , Loving County Lubbock County 252,284 5,635 12,776 7,539 3, Lynn County 6, McCulloch County 7,

16 TEXAS cont'd McLennan County 224,668 5,201 11,313 6,720 2, McMullen County Madison County 13, Marion County 10, Martin County 4, Mason County 3, Matagorda County 37, ,880 1, Maverick County 51,181 1,595 2,261 1, Medina County 43,027 1,000 2,179 1, Menard County 2, Midland County 121,371 3,039 5,992 3,594 1, Milam County 25, , Mills County 5, Mitchell County 9, Montague County 19, , Montgomery County 378,033 9,074 18,749 11,123 4, Moore County 20, Morris County 12, Motley County 1, Nacogdoches County 60,468 1,280 3,112 1, Navarro County 48,687 1,149 2,452 1, Newton County 14, Nolan County 14, Nueces County 319,704 7,786 15,899 9,505 4, Ochiltree County 9, Oldham County 2, Orange County 84,983 1,925 4,379 2,642 1, Palo Pinto County 27, , Panola County 22, , Parker County 102,801 2,240 5,309 3,171 1, Parmer County 9, Pecos County 15, Polk County 46, ,551 1, Potter County 119,852 3,067 5,806 3,445 1, Presidio County 7, Rains County 11, Randall County 110,053 2,410 5,670 3,384 1, Reagan County 2, Real County 3, Red River County 13, Reeves County 11, Refugio County 7, Roberts County Robertson County 16, Rockwall County 62,944 1,490 3,128 1, Runnels County 10, Rusk County 47, ,549 1, Sabine County 10, San Augustine County 8, San Jacinto County 24, , San Patricio County 69,209 1,817 3,333 1, San Saba County 6, Schleicher County 2, Scurry County 16, Shackelford County 3, Shelby County 26, , Sherman County 3, Smith County 190,594 4,399 9,721 5,841 2, Somervell County 7, Starr County 60,941 1,981 2,616 1, Stephens County 9, Sterling County 1, Stonewall County 1, Sutton County 4, Swisher County 7, Tarrant County 1,620,479 40,427 78,750 46,443 17,246 1,085 Taylor County 125,039 2,938 6,277 3,737 1, Terrell County Terry County 12, Throckmorton County 1, Titus County 29, , Tom Green County 103,611 2,339 5,305 3,176 1, Travis County 888,185 19,420 44,614 25,935 8, Trinity County 14, Tyler County 20, , Upshur County 37, ,982 1, Upton County 3,

17 TEXAS cont'd Uvalde County 26, , Val Verde County 47,596 1,307 2,261 1, Van Zandt County 52,491 1,112 2,787 1, Victoria County 85,648 2,119 4,265 2,568 1, Walker County 62, ,452 1, Waller County 34, ,765 1, Ward County 10, Washington County 31, ,671 1, Webb County 224,695 7,415 9,468 5,534 2, Wharton County 41,554 1,013 2,085 1, Wheeler County 4, Wichita County 125,894 2,825 6,431 3,834 1, Wilbarger County 13, Willacy County 20, Williamson County 333,457 8,349 16,084 9,426 3, Wilson County 37, ,902 1, Winkler County 6, Wise County 56,696 1,278 2,888 1, Wood County 40, ,271 1, Yoakum County 7, Young County 18, Zapata County 13, Zavala County 11, CHICAGO CONSTITUENT 5,303, , , ,101 67,175 3,988 ALA OF METROPOLITAN CHICAGO Cook County 5,303, , , ,101 67,175 3,988 CONNECTICUT CONSTITUENT 3,510,297 74, , ,370 49,907 2,423 ALA OF CONNECTICUT Fairfield County 902,775 20,473 54,510 28,109 12, Hartford County 877,393 18,485 54,182 28,012 12, Litchfield County 190,071 3,803 11,880 6,246 2, Middlesex County 163,214 3,214 10,294 5,316 2, New Haven County 846,766 17,748 52,515 26,860 12, New London County 266,618 5,532 16,625 8,441 3, Tolland County 147,634 2,700 9,630 4,737 1, Windham County 115,826 2,362 7,292 3,650 1, DISTRICT OF COLOMBIA CONSTITUENT ALA OF THE DISTRICT OF COLUMBIA 550,521 10,042 40,280 17,596 7, District of Columbia 550,521 10,042 40,280 17,596 7, ALA OF FLORIDA 17,789, , , , ,135 12,668 Alachua County 223,852 3,875 12,113 7,068 2, Baker County 24, , Bay County 161,558 3,383 8,438 5,172 2, Bradford County 28, , Brevard County 531,250 9,879 28,589 18,095 9, Broward County 1,777,638 38,795 91,270 55,779 25,343 1,289 Calhoun County 13, Charlotte County 157,536 2,174 8,993 6,066 4, Citrus County 134,370 1,984 7,578 5,039 3, Clay County 171,095 3,839 8,756 5,251 2, Collier County 307,242 5,706 16,418 10,549 5, Columbia County 64,040 1,371 3,310 2, DeSoto County 35, ,841 1, Dixie County 14, Duval County 826,436 19,705 41,215 24,650 10, Escambia County 296,772 6,223 15,421 9,439 4, Flagler County 76,410 1,195 4,254 2,739 1, Franklin County 10, Gadsden County 46,428 1,068 2,344 1, Gilchrist County 16, Glades County 11, Gulf County 13, Hamilton County 13, Hardee County 28, , Hendry County 39,561 1,050 1,865 1, Hernando County 158,409 2,666 8,676 5,656 3, Highlands County 95,496 1,629 5,178 3,445 2, Hillsborough County 1,132,152 25,643 57,383 34,468 14, Holmes County 19, , Indian River County 128,594 2,158 7,047 4,604 2, Jackson County 48, ,618 1, Jefferson County 14, Lafayette County 7, Lake County 277,035 4,898 14,922 9,700 5,