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The population of the United States has grown almost 123 times since the first federal census was conducted after the Declaration of Independence.

Most of the counties with an older population were located outside of the metro or micro areas, the release states.

The United States’ population growth slowed in the past 10 years to its lowest rate since the 1930s, according to data released Monday by the U.S. Census Bureau.

For decades, the total fertility rate in the United States has been below the replacement fertility rate—the level of fertility necessary for the current generation to replace itself.

Physician shortages in the United States are projected to worsen, especially in rural areas. The authors argue that broad reforms, including changes in education and compensation, are needed.

The new U.S. Census Bureau estimates showed Florida, California and Texas among the top three states to see a surge in their migrant populations.