What are the States with the least healthy (and healthiest) populations?

Good health allows you to do the things you love and live life to the fullest. However, many Americans suffer from chronic diseases that reduce their quality of life. According to the Centers for Disease Control and Prevention (CDC), six out of ten American adults have at least one chronic disease, and four out of ten have two or more.

The CDC defines a chronic condition as a condition that lasts at least a year and requires ongoing medical intervention or interferes with activities of daily living - or both.

Unfortunately, the number of chronic diseases is projected to increase over the next few decades. According to the Journal of the American College of Cardiology, between 2025 and 2060, the number of Americans with diabetes will increase by 39.3%, hypertension by 27.2%, and obesity by 18.3%.

Some states have higher rates of chronic disease than others, due in part to unhealthy lifestyles and high rates of substance abuse.

To determine which states have the healthiest and least healthy populations, we compared all 50 states on 21 indicators covering three categories: risk factors and disease prevalence, substance abuse, and lifestyle and health outlook. We also examined data from the 100 most populous counties (91 of which had available data) to determine which counties had the least healthy populations.

The study identified five states and counties with the least healthy populations based on high rates of chronic disease, substance abuse, and unhealthy lifestyles. If you live in one of these states or counties, take steps to improve your health by making lifestyle changes and using preventive services. Your health is your most valuable asset.

Key findings

• West Virginia tops the list of states with the least healthy residents, while Hawaii tops the list of states with the healthiest residents.
• Eight of the 10 least healthy states are in the South: West Virginia, Mississippi, Tennessee, Arkansas, Kentucky, Alabama, Louisiana and Oklahoma.
• Five of the 10 healthiest states are on the East Coast: Connecticut, Massachusetts, New Jersey, New Hampshire and New York.
• Mississippi ranks worst in the Risk Factors and Disease Prevalence category, West Virginia residents have the worst health habits and outlook, and Vermont is the worst state for substance abuse.
• At the county level, the least healthy population resides in Wayne County, Michigan and the healthiest population resides in Utah County, Utah .

Top 5 least healthy states

1. West Virginia

West Virginia's score: 100 out of 100

West Virginia is the unhealthiest state in America, according to our analysis. The Mountain State ranks worst in our Lifestyle and Health Outlook category.

West Virginia's sobering statistics include:

• The highest percentage of adults who smoke (21%).
• The highest percentage of adults with obesity (41%).
• Second in life expectancy (73.9 years).
• The third highest percentage of adults who had not exercised in the past month (30.2%).

West Virginia also ranks second in the Risk Factors and Disease Prevalence category. West Virginia stands out as the state with the highest number of diseases:

• The highest percentage of adults with high cholesterol (41%).
• Diabetes has the highest mortality rate (41.7 deaths per 100,000 state residents).
• Kidney disease has the second highest mortality rate (21.07 deaths per 100,000 state residents).
• Second highest cancer mortality rate (178.9 deaths per 100,000 state residents).
• The second highest percentage of adults with high blood pressure (43.4%).
• The third highest percentage of adults with diagnosed diabetes (13.1%).
• The third highest rate of deaths from chronic lower respiratory disease (60.07 deaths per 100,000 state residents).
• Fifth highest hypertension death rate (12.33 deaths per 100,000 state residents).

Of all 50 states, West Virginia also has the highest rate of drug overdose deaths (75.03 per 100,000 state residents), more than 50% higher than the second ranked state (Delaware).

2. Mississippi

Mississippi's score: 96.04 out of 100

The Magnolia State ranks worst in our category for risk factors and disease prevalence. Mississippi has the highest rate of hypertension in the nation, with 43.9% of adults having high blood pressure. This puts many residents at increased risk for cardiovascular disease and stroke.

The state also has the highest percentage of adults diagnosed with diabetes - 13,7%. Uncontrolled diabetes can lead to serious complications, including heart and kidney disease.

In addition, Mississippi stands out as the state with the most:

• Highest cancer mortality rate (178.97 deaths per 100,000 state residents).
• Highest death rate due to hypertension (17.37 deaths per 100,000 state residents).
• Kidney disease has the highest mortality rate (21.8 deaths per 100,000 state residents).
• Highest rate of stroke deaths (54.8 deaths per 100,000 state residents).
• The state has the second highest mortality rate for diabetes (38.53 deaths per 100,000 state residents) and cardiovascular disease (242.5 deaths per 100,000 state residents).
• Fifth highest mortality rate for chronic lower respiratory disease (58.4 deaths per 100,000 state residents).
• The fifth highest percentage of adults with high cholesterol (38.3%).

Mississippi ranks second in the nation for lifestyle and health. It has the lowest life expectancy in the nation (73.63 years). And Mississippi adults are the most likely to report not exercising in the past month (31.9%).

The state also has the fourth highest rates of obesity (39.5% of adults) and smoking (17.4%, on par with Kentucky).

3. Tennessee

Tennessee's score: 94.39 out of 100

Tennessee ranks fourth in both the Lifestyle and Health Outlook and Substance Abuse categories. Tennessee has the highest rates of opioid abuse (3,743.97 per 100,000 adults) and prescription painkiller abuse (3,190.88 per 100,000 adults) in the nation. This is indicative of a serious opioid epidemic in the state.

Tennessee also stands out among other states:

• The third highest percentage of adults who smoke (18.5%).
• Fifth highest rate of drug overdose deaths (44.47 deaths per 100,000 state residents).
• The fifth highest percentage of obese adults (38.9%).
• The sixth highest percentage of adults who had not exercised in the past month (27.7%).

Tennessee also has the sixth highest life expectancy in the U.S. at just 74.97 years.

In terms of risk factors and disease prevalence, the country ranks fifth:

• Fifth highest cancer mortality rate (165.9 deaths per 100,000 state residents, on par with Arkansas).
• Sixth highest rate of deaths from cardiovascular disease (212.87 deaths per 100,000 state residents).
• The sixth highest percentage of both adults with diagnosed diabetes (12.2%) and adults with high cholesterol (38%).
• Seventh highest rate of deaths due to diabetes (29.13 deaths per 100,000 state residents).
• Eighth highest rate of deaths from hypertension (11.53 deaths per 100,000 state residents) and chronic lower respiratory disease (51.9 deaths per 100,000 state residents).

Arkansas' score: 88.06 out of 100

Arkansas ranks third in disease risk factors and has very high mortality rates for major causes of death such as cardiovascular disease, cancer, diabetes, and respiratory disease.

Arkansas stands out among other states:

• Chronic lower respiratory disease has the second highest mortality rate (60.7 deaths per 100,000 state residents).
• Diabetes has the third highest mortality rate (34.3 deaths per 100,000 state residents).
• Fourth highest rate of deaths from cardiovascular disease (226.67 deaths per 100,000 state residents).
• The fourth highest percentage of adults with high blood pressure (40.7%).
• Fifth highest cancer mortality rate (165.9 deaths per 100,000 state residents, on par with Tennessee).
• Sixth in mortality rates for kidney disease (18.87 deaths per 100,000 state residents) and stroke (44.7 deaths per 100,000 state residents).

In terms of lifestyle and health status, Arkansas ranks seventh. The state is home to the second highest percentage of adults who smoke (18.7%). Arkansas residents are also the second most likely to have not exercised in the past month (31.2%).

On top of that, the Natural State has the seventh highest life expectancy (75.03 years) and the second highest adult opioid abuse rate: 3,447.55 per 100,000 state residents reported opioid abuse in the past year. The state also has the second highest number of adults reporting abuse of prescription painkillers in the past year (3,119.22 per 100,000 state residents).

5. Kentucky

Kentucky's score: 87.46 out of 100

The Blue Grass State rounds out our list as the fifth least healthy state. Kentucky ranks sixth in both risk factors and disease prevalence, as well as lifestyle and health outlook.

Kentucky stands out among other states:

• Third highest cancer mortality rate (178.27 deaths per 100,000 state residents).
• The third highest rate of drug overdose deaths (45.77 deaths per 100,000 state residents).
• Fourth highest mortality rate for chronic lower respiratory disease (58.7 deaths per 100,000 state residents).
• Fourth in life expectancy (74.77).
• Fourth highest rate of adult smokers (17.4%, on par with Mississippi).
• The fifth highest percentage of adults with diagnosed diabetes (12.3%).
• Sixth highest rate of deaths due to diabetes (29.77 deaths per 100,000 state residents).
• The sixth highest percentage of adults with high blood pressure (39.9%).

Kentucky also has the seventh highest rate of deaths from cardiovascular disease (206.13 deaths per 100,000 state residents) and kidney disease (18.5 deaths per 100,000 state residents).

Top 5 healthiest states

Hawaii's score: 0 out of 100

According to our research, Hawaii is the healthiest state in the United States. It ranks first for low levels of disease risk factors and healthy lifestyles.

Aloha State boasts:

• Lowest mortality rate for chronic lower respiratory disease (17.83 deaths per 100,000 state residents).
• Highest life expectancy in the country (80.87 years).
• The second highest percentage of obese adults (25.9%).
• The second highest rate of deaths from cardiovascular disease (123.93 deaths per 100,000 state residents).
• Second in cancer mortality rate (125.5 deaths per 100,000 state residents).
• Chronic liver disease has the second highest mortality rate (8.37 deaths per 100,000 state residents).
• Diabetes has the third highest mortality rate (16.83 deaths per 100,000 state residents).
• The sixth highest percentage of adults who smoke (10%, in line with Connecticut and Washington).

Hawaii also ranked second in the Substance Abuse category. The state has the lowest alcohol-related death rate of any other state (7.37 deaths per 100,000 state residents).

Hawaii also stands out among other states:

• Fifth highest number of adults reporting illicit drug use in the past month (8,332.2 per 100,000 state residents).
• Ninth highest rate of drug overdose deaths (17.17 deaths per 100,000 state residents).
• The 10th highest number of adults reporting opioid abuse in the past year (2,291.35 per 100,000 state residents).

2. Utah

Utah's score: 11.34 out of 100

Right behind Hawaii is Utah. It is the second healthiest state, has the fourth-highest percentage of heavy drinking adults (5%) and the fourth-highest number of adults reporting illicit drug use in the past month (8,075.01 per 100,000 state residents).

Utah also ranks sixth in our category assessing lifestyle habits and health outlook. It is home to the lowest percentage of adults who smoke (6.7%). Utah residents are the second most likely to have not exercised in the past month (16.9%).

When it comes to disease risk factors, Beehive Country ranked seventh in this category.

Utah boasts that:

• Lowest cancer mortality rate (119.23 deaths per 100,000 state residents).
• The second highest percentage of adults with high blood pressure (26.6%).
• The fourth highest percentage of adults with high cholesterol (31.6%).
• Sixth highest rate of deaths from chronic liver disease (10.23 deaths per 100,000 state residents).

3. Connecticut

Connecticut's score: 13.33 out of 100

Connecticut ranks third among the healthiest states, including third in risk factors and disease prevalence. It has:

• Lowest diabetes mortality rate (16.33 deaths per 100,000 state residents).
• Fourth highest mortality rate for chronic lower respiratory disease (25.33 deaths per 100,000 state residents).
• Fourth highest rate of stroke deaths (28.2 deaths per 100,000 state residents).
• Seventh highest rate of deaths from cardiovascular disease (139.4 deaths per 100,000 state residents) and hypertension (6.77 deaths per 100,000 state residents).
• Eighth highest cancer mortality rate (133.07 deaths per 100,000 state residents).

Connecticut also ranks seventh in the Lifestyle and Health Outlook category. The state boasts the sixth longest life expectancy (79.7). Along with Hawaii and Washington, D.C., it ranks sixth in adult smoking rates (10%).

4. Minnesota

Minnesota's score: 16.16 out of 100

The Land of 10,000 Lakes is also the fourth healthiest state in the country. It ranks fifth in risk factors and disease prevalence.

Minnesota has the lowest rate of deaths from cardiovascular disease of any other state (119.57 deaths per 100,000 state residents). It also has the second highest percentage of adults with high cholesterol (31.4%).

There are also disease-related indicators in the state:

• Fourth highest mortality rate for kidney disease (7.37 deaths per 100,000 state residents).
• The fourth highest percentage of adults with high blood pressure (29.5%).
• Ninth highest percentage of adults with diagnosed diabetes (7.9%).
• Ninth highest mortality rate for chronic lower respiratory disease (30.6 deaths per 100,000 state residents).

In addition, Minnesota residents have the third highest life expectancy (80 years) and the fourth highest number of adults reporting opioid abuse in the past year (2,203.88 per 100,000 state residents).

5. Massachusetts

Massachusetts score: 17.02 out of 100

Massachusetts is the fifth healthiest state on our list, ranking second in the Risk Factors and Disease Prevalence category.

Massachusetts boasts that:

• Diabetes has the second highest death rate (16.6 deaths per 100,000 state residents).
• The second highest rate of stroke deaths (25.57 deaths per 100,000 state residents).
• Third highest rate of deaths from cardiovascular disease (129.37 deaths per 100,000 state residents).
• The sixth highest percentage of adults with diagnosed diabetes (7.8%).
• The seventh highest mortality rate for chronic lower respiratory disease (28.63 deaths per 100,000 state residents) and chronic liver disease (10.3 deaths per 100,000 state residents).

Massachusetts ranked as the fourth best state for lifestyle and health outlook. Scores in this category include:

• The fourth highest percentage of obese adults (27.2%).
• Fourth in life expectancy (79.83 years).
• The eighth highest percentage of adults who smoke (10.4%).

Top 5 least healthy counties

1. Wayne County, Michigan

Wayne County Score : 100 out of 100

According to our analysis, Wayne County is the unhealthiest county in America. The county has the highest prevalence rate of multiple diseases and disease-causing habits, including smoking and lack of exercise.

Wayne County statistics include:

• Highest percentage of adults with chronic obstructive pulmonary disease (8.8%)
• Highest percentage of adults who had a stroke (4.1%)
• Highest percentage of adults who are current smokers (21.7%)
• Second highest percentage of adults with cardiovascular disease (7%) and high blood pressure (39.5%)
• The third highest percentage of adults with chronic kidney disease (3.8%)
• Eighth highest proportion of adults with diagnosed diabetes (13.3%)
• Ninth highest percentage of adults who do not exercise (28.3%)

2. Cuyahoga County, Ohio

Cuyahoga County Score : 99.38 out of 100

Cuyahoga County is the county with the highest percentage of adults with cardiovascular disease in the nation (7.2%), putting many residents at increased risk for potentially fatal complications including heart attacks, strokes, and aneurysms.

Cuyahoga County statistics include:

• The second highest percentage of adults with chronic obstructive pulmonary disease (8.5%)
• Fourth highest percentage of adults who have had a stroke (3.8%)
• Fourth highest proportion of adults with high blood pressure (37.3%)
• Fifth highest proportion of adults with chronic kidney disease (3.6%)
• Sixth highest proportion of adults with diagnosed diabetes (13.6%), cancer (7.5%) and adults who smoke (18%)

3. Jefferson County, Kentucky

Jefferson County Score: 98.41 out of 100

Jefferson County has a high rate of chronic health conditions, including high blood pressure, which can put additional strain on the body's vascular system. This also means that many residents need to monitor and manage their chronic conditions on a daily basis.

Jefferson County also stands out among other counties:

• The third highest percentage of adults with cardiovascular disease (6.6%) and chronic obstructive pulmonary disease (8.2%)
• Fourth highest percentage of adults with high blood pressure (37.3%)
• Sixth highest proportion of adults with high cholesterol (37.4%)
• Seventh highest proportion of adults who smoke (17.8%) and do not exercise (28.7%)
• 10th highest proportion of obese adults (37.3%)

4. Macomb County, Michigan

Macomb County Score : 94.63 out of 100

Macomb County is among the top ten counties with a high percentage of adults with obesity and high blood pressure.

Macomb County statistics also include:

• Third highest percentage of adults with cardiovascular disease (6.6%)
• Fourth highest proportion of adults with cancer (7.6%) and high cholesterol (37.7%)
• Fifth highest proportion of adults with chronic obstructive pulmonary disease (7.8%) and smokers (18.6%)
• Seventh highest proportion of obese adults (37.8%)
• Ninth highest percentage of adults with high blood pressure (36.2%)

5. Erie County, New York

Erie County Score : 93.83 out of 100

Erie County has the highest percentage of adults with cancer (7.7%), indicating a serious health crisis in the region. It also has a high rate of chronic diseases and disease-causing habits, including smoking.

Erie County stands out among other counties:

• Sixth highest proportion of adults with chronic obstructive pulmonary disease (7.5%)
• Seventh highest proportion of adults with cardiovascular disease (6.5%)
• 10th highest proportion of adults who are current smokers (17%)
• 11th highest proportion of adults with high cholesterol (36.9%)

How health affects life insurance rates

Your health can have a significant impact on how much life insurance costs. Insurance companies evaluate your medical history and health risks when pricing a policy, so maintaining good health can lower your premiums.

When getting life insurance quotes, the insurer will likely require a medical exam for policies over a certain amount, unless you get life insurance without an exam. The examiner will check your vitals, including blood pressure, cholesterol levels, and nicotine use. Conditions such as high blood pressure, heart disease and diabetes can increase premiums.

To get cheap life insurance or get tips on how to pass a life insurance exam, focus on improving your health: eat right, exercise regularly, quit smoking and cut down on alcohol. Controlling chronic conditions can also help.

There are many factors that affect life insurance premiums, and nicotine is one of the main ones. Life insurance for smokers is significantly more expensive than non-smokers - sometimes twice as much. Quitting the habit for at least 12 months can lower rates.

Your weight, body mass index (BMI) and cholesterol level are also taken into account. Being overweight or obese can increase your insurance premiums. Weight loss, proper diet and exercise can help counteract this.

Insurers also ask if there is a family history of serious health conditions such as cancer, heart disease or stroke. While you can't change genetics, focus on reducing lifestyle risks through diet, exercise and regular checkups.

For many people, life insurance is worth the cost. Comparing types of life insurance and policies can also help you find the best life insurance at an affordable rate.

With a little diligence, you can find an affordable rate for the amount of life insurance you need, even if you have health issues. Just be sure to accurately list your medical history and health status when you apply. Knowing this information ahead of time can help you avoid problems later on if you need to apply for life insurance.

Compare life insurance companies

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State ranking methodology

To determine which states have the healthiest and least healthy populations, we compared all 50 states in three key categories: disease risk factors and prevalence, substance abuse and lifestyle habits, and health outlook.

We considered 21 relevant metrics, which are listed below with their respective weights:

Risk factors and prevalence of diseases - Total points: 61.5

• Cancer mortality rate per 100,000 state residents: 6% rates. Data is from the Centers for Disease Control and Prevention. For this rate, we took a three-year average using data from 2019 through 2021.
• Diabetes mortality rate per 100,000 state residents: 6% of the total. Data is from the Centers for Disease Control and Prevention. For this rate, we took a three-year average using data from 2019 through 2021.
• Heart disease mortality rate per 100,000 state residents: 6% of the total. Data is from the Centers for Disease Control and Prevention. For this rate, we took a three-year average using data from 2019 through 2021.
• Hypertension death rate per 100,000 state residents: 6% of the total. Data is from the Centers for Disease Control and Prevention. For this rate, we took a three-year average using data from 2019 through 2021.
• Kidney disease mortality rate per 100,000 state residents: 6% of the total. Data is from the Centers for Disease Control and Prevention. For this rate, we took a three-year average using data from 2019 through 2021.
• Chronic lower respiratory disease (CLRD) mortality rate per 100,000 state residents: 6% of the total. COPD includes chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, and asthma. Data are from the Centers for Disease Control and Prevention. For this indicator, we took a three-year average using data from 2019 through 2021.
• Stroke mortality rate per 100,000 state residents: 6% of the total. Data is from the Centers for Disease Control and Prevention. For this rate, we took a three-year average using data from 2019 through 2021.
• Chronic liver disease/cirrhosis mortality rate per 100,000 state residents: 6% of the total. Data is from the Centers for Disease Control and Prevention. For this rate, we took a three-year average using data from 2019 through 2021.
• Percentage of adults with high cholesterol: 4.5% of total. Data are from CDC's Behavioral Risk Factor Surveillance System (BRFSS), 2021.
• Percentage of adults with high blood pressure: 4.5% of the total. Data taken from BRFSS, 2021.
• Percentage of adults with diagnosed diabetes: 4.5% of the total. Data obtained from Kaiser Family Foundation (KFF), 2021.

Substance abuse - Total points: 25

• Alcohol-related death rate per 100,000 state residents: 6% of the total. The data was obtained from KFF. For this rate, we took a three-year average using data from 2019 through 2021.
• Drug overdose death rate per 100,000 state residents: 6% of the total. Data is from the Centers for Disease Control and Prevention. For this rate, we took a three-year average using data from 2019 through 2021.
• Number of adults reporting illicit drug use in the past month per 100,000 state residents: 3.25% of the total. Data are from the Substance Abuse and Mental Health Services Administration (SAMHSA), 2021 report.
• Number of adults reporting opioid abuse in the past year per 100,000 state residents: 3.25% of the total. Data taken from SAMHSA, 2021.
• Number of adults reporting prescription painkiller abuse in the past year, per 100,000 state residents: 3.25% of the total. Data taken from SAMHSA, 2021.
• Percentage of adults who are heavy drinkers: 3.25% of the total. This metric reflects the percentage of adult males who consume more than 14 drinks per week and the percentage of adult females who consume more than 7 drinks per week. Data are from BRFSS, 2022.

Lifestyle and health perspectives - Total points: 13.5

• Life expectancy at birth: 5% of outcome. Data is from the Centers for Disease Control and Prevention. For this indicator, we took a three-year average using data from 2018 through 2020.
• Percentage of adults who are obese: 3.25% of the total. Data taken from CDC, 2022.
• Percentage of adults who currently smoke: 3.25% of the total. Data obtained from BRFSS, 2022.
• Percentage of adults who did not exercise in the past month: 2% of total. Data obtained from BRFSS, 2022.

Methodology for ranking districts

To determine which counties have the least healthy populations, we examined data from the 100 most populous counties (91 of which had access to the data).

We have considered the following 12 indicators:

• Percentage of adults with diagnosed diabetes: 10% of the total.
• Percentage of adults with cancer: 10% of the total.
• Percentage of adults with cardiovascular disease: 10% of the total.
• Percentage of adults with chronic obstructive pulmonary disease: 10% of total.
• Percentage of adults with chronic kidney disease: 10% of total.
• Percentage of adults who have had a stroke: 10% of the total.
• Percentage of adults with high blood pressure: 8% of the total.
• Percentage of adults with high cholesterol: 8% of the total.
• Percentage of adults who report binge drinking: 6.5% of the total.
• Percentage of adults who are current smokers: 6.5% of the total.
• Percentage of adults who are obese: 6.5% of the total.
• Percentage of adults who do not participate in sports: 4.5% of the total.

Data for all indicators are from the Centers for Disease Control and Prevention, 2021.