The number of Americans receiving Social Security Disability Insurance (SSDI) more-than doubled over the past two decades, from 5.2 million to 11.7 million by the end of 2011.

The number of residents receiving disability insurance from the Social Security Administration (SSA) varies from state to state. In West Virginia, close to one in every 10 people aged 18 to 64 was receiving SSDI benefits from the federal government, more than three times the rate in states like Utah and Alaska.

Click here to see the states with the most Americans on disability

The proportion of eligible workers applying for disability benefits also has doubled in the past 10 years, according to the SSA. Two main reasons are driving the increase, explains The National Association of Social Security Claimants’ Representatives. First, baby boomers are entering years in which they are more prone to disability. Second, women who began to work in greater numbers in the 1970s and 1980s are also now eligible for disability through Social Security for the first time.

However, changing demographics only partially explain the increase. Tad DeHaven, budget analyst at the Cato Institute, a libertarian think tank, explained that the recession played a major role in the growth in disability claims. “When you see unemployment rates rising, you see disability moving with it,” DeHaven noted.

In fact, states with the highest disability claims tend to have the highest poverty rates and the fewest jobs offering competitive wages. Seven of the 10 states with the most residents receiving disability have among the highest poverty rates in the country. The number of jobs in these states in manufacturing and retail, which tend to pay modest wages, are above the national average. Meanwhile, jobs in finance and professional occupations are scarce.

While it is true that disability claims rise when the economy is in trouble, disability claims also skew the unemployment rate. The vast majority of disability claimants do not work and are therefore not counted as part of the labor force, which the government uses to calculate unemployment. Of the 10 states with highest proportion of 18 to 64 year olds on Social Security disability, seven have among the lowest labor force participation rates in the country. Unemployment rates in these states, six of which are already above the national average, would be even higher if those on disability were counted.

In principle, the reason Americans apply for disability is because their health prevents them from working. A review of a recent Gallup-Healthways survey shows that nearly these states with the highest rates of disability are in the top 10 for serious conditions, including heart attacks, diabetes, hypertension and recurring knee, leg and back pain. West Virginia, the state with the highest disability rate, had either the highest or the second-highest rate in the country for all of these conditions.

Residents in these states find it hard to get a job that will pay much more than disability with their work experience, education and health condition, explained Gary Burtless, economist and senior fellow at the Brookings Institution. “In states like Alabama and West Virginia,” Burtless said, “lots of the workers are going to be in occupations where the next job they obtain — if they do stick it out and work through the pain and the disability — is one that is going to pay considerably less than the last job that they held.”

To determine the 10 states with the most residents getting disability benefits, 24/7 Wall St. relied on figures published by the Social Security Administration in its Annual Statistical Report on the Social Security Disability Insurance Program for December 2011, the most recent available data. We only considered the number of claimants and average payment from the SSA. Unlike SSA, Supplemental Security Income, another federal disability program, provides financial support to low-income residents, children and senior citizens, regardless of work history. Statistics on labor force participation and average annual unemployment rates were provided by the Bureau of Labor Statistics for 2011. Figures for the percentage of residents suffering from a specific disease or condition are from the Gallup-Healthways Well Being Index. Education, income and poverty statistics are from the U.S. Census Bureau.

These are the states with the most Americans on disability.

10. Michigan
> Pct. receiving disability benefits: 6.0%
> Pct. with recurring neck and back pain: 32.3% (12th highest)
> 2011 labor force participation: 60.3% (7th lowest)
> 2011 unemployment: 10.4% (tied for 6th highest)

At the end of 2011, disabled workers in Michigan received in total $390 million a month from SSDI, more than all but five other states. The state not only had a relatively high number of disabled workers, but also paid them more than most states. On average, disabled workers in Michigan received $1,166 per month in December 2011 from SSDI, more than in all but three other states. Nearly 23% of these recipients received more than $1,600 per month from the program, more than anywhere in the country except New Jersey. Between 2006 and 2011, Michigan’s labor force participation rate declined by five percentage points, from 65.3% to just 60.3% of the population.

9. Missouri
> Pct. receiving disability benefits: 6.1%
> Pct. with recurring neck and back pain: 30.5% (24th lowest)
> 2011 labor force participation rate: 65.0% (25th highest)
> 2011 unemployment rate: 8.4% (22nd highest)

Missouri had an average unemployment rate of 8.4% in 2011, lower than the nationwide rate of 8.9%. Many jobless adults were actively seeking a job, a fact that qualifies them received Medicaid or Temporary Assistance for Needy Families (TANF). Still, Missouri was contemplating a welfare transfer program that would move Medicaid and TANF recipients– who must be be employed or taking steps towards employment — onto federal disability programs. To assist in implementing the plan, Missouri would hire Public Consulting Group, which touts its ability to improve the rate at which states’ residents are approved for disability benefits. Opponents of the plan say the initiative would trap families in poverty.

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8. South Carolina
> Pct. of working age population with benefits: 6.3%
> Pct. with recurring neck and back pain: 30.1% (20th lowest)
> 2011 labor force participation rate: 60.0% (6th lowest)
> 2011 unemployment rate: 10.4% (tied for 6th highest)

South Carolina had one of the nation’s highest poverty rates in 2011, when nearly 19% of the population lived below the poverty line. It also had one of the nation’s lowest median annual household incomes, at just over $42,000. South Carolina not only had one of the nation’s highest average unemployment rates in 2011, but also one of the lowest labor force participation rate (unemployed workers actively seeking a job). Meanwhile, few other states had a larger percentage of workers receiving SSDI benefits, which does not require recipients to actively look for a job. State residents were among the most likely to attribute their disability to diseases affecting the musculoskeletal and circulatory systems, such as back pain. South Carolina residents were among the most likely to have high cholesterol or blood pressure, or to have been diagnosed with diabetes in 2012.

7. Tennessee
> Pct. of working age population with benefits: 6.5%
> Pct. with recurring neck and back pain: 32.4% (11th highest)
> 2011 labor force participation rate: 62.7% (16th lowest)
> 2011 unemployment rate: 9.3% (15th highest)

Tennessee had more than 260,000 Social Security disability beneficiaries between the ages of 18 and 64 as of the end of 2011. As a result, disabled workers in the state received a total of $261.5 million in December 2011 from SSDI. Beneficiaries in Tennessee were among the most likely in the nation to receive benefits due to diseases of the circulatory system. According to a Gallup-Healthways survey, state residents were among the most likely in the nation to have diabetes or high cholesterol or to have had a heart attack in 2012.

6. Maine
> Pct. of working age population with benefits: 7.4%
> Pct. with recurring neck and back pain: 33.0% (10th highest)
> 2011 labor force participation rate: 65.2% (24th highest)
> 2011 unemployment rate: 7.7% (22nd lowest)

Although a large percentage of Maine residents received SSDI benefits in December 2011, the typical payment was limited. The monthly disability benefit in Maine was just $1,030 on average, the lowest in the nation. Just 11.5% of those with benefits received at least $1,600, the lowest proportion in the nation and well below the 17.2% nationwide that December. More than 43% of residents who received disability at the end of 2011 were diagnosed as disabled due to a mental disorder, one of the highest in the nation and well above the 35.8% average for all areas.

5. Mississippi
> Pct. of working age population with benefits: 7.7%
> Pct. with recurring neck and back pain: 30.3% (23rd lowest)
> 2011 labor force participation rate: 59.6% (4th lowest)
> 2011 unemployment rate: 10.5% (4th highest)

Mississippi had the highest poverty rate in 2011 with 22.6% of residents living below the poverty line. Additionally, the state’s median annual household income that year was the lowest in the nation at slightly less than $37,000. Many residents could not find a job even if they were actively looking. In 2011, Mississippi’s average unemployment rate was the nation’s fourth highest. Additionally, a mere 59.6% of the population participated in the workforce as of 2011, the fourth lowest percentage of all states. Potentially related to the state’s high levels of poverty, as well as obesity, 11.3% of SSDI beneficiaries suffered from a circulatory system disease in December 2011. This was the highest of any state, and well above the 7.7% of beneficiaries nationally.

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4. Kentucky
> Pct. of working age population with benefits: 8.1%
> Pct. with recurring neck and back pain: 34.8% (5th highest)
> 2011 labor force participation rate: 61.5% (10th lowest)
> 2011 unemployment rate: 9.5% (12th highest)

More than 19% of Kentucky’s population lived in poverty in 2011, a higher percentage than all but four states. Many people in Kentucky may not have the means to get well-paying work. Just 83.1% of people have at least a high school diploma, the sixth lowest percentage of all states. Meanwhile, just 21.1% of adults have at least a bachelor’s degree, the fifth lowest percentage of all states. As of 2011, just 61.5% of Kentuckians were considered to be in the labor force, among the lowest rates in the nation. In a well-publicized case, a Kentucky judge, David Daugherty, was accused in a civil suit filed in February of improperly approving Social Security benefits in order to help local attorney Eric Conn, arguably the most prominent disability lawyer in the region, receive millions of dollars from the federal government for handling these cases.

3. Alabama
> Pct. of working age population with benefits: 8.1%
> Pct. with recurring neck and back pain: 34.6% (6th highest)
> 2011 labor force participation rate: 58.5% (2nd lowest)
> 2011 unemployment rate: 8.7% (19th highest)

Alabama was one of the nation’s poorest states as of 2011, with a median annual income of just $41,415. Additionally, educational attainment in the state was limited, with just 82.7% of all residents holding a high school diploma and just 22.3% a college degree in 2011. That year, the state’s average unemployment rate was 8.7%, slightly lower than the U.S. average rate of 8.9% for the year. However, just 58.5% of the population participated in the labor force as of 2011, lower than all states except for West Virginia. In December 2011, SSDI recipients in Alabama were far more likely to receive payments due to diseases of the circulatory system or the musculoskeletal system than recipients in the large majority of other states. Alabamians were among the most likely Americans surveyed in 2012 to state they had experienced a heart attack or were diabetic.

2. Arkansas
> Pct. of working age population with benefits: 8.2%
> Pct. with recurring neck and back pain: 36.1% (2nd highest)
> 2011 labor force participation rate: 60.4% (8th lowest)
> 2011 unemployment rate: 7.9% (24th lowest)

In 2011, the median annual income in Arkansas was just $38,758, the third lowest of all states in the United States. Arkansas is also among the least educated states in the country. Workers with limited education and who are out of work generally have a harder time getting back to work. For instance, just 20.3% of Arkansas residents had at least a bachelor’s degree, lower than all but two other states. An estimated 31.6% of SSDI recipients in Arkansas had musculoskeletal system disease in December 2011, more than any other state except for Alabama. Meanwhile, more than 9% of recipients had diseases involving the circulatory system, higher than all but six other states.

1. West Virginia
> Pct. of working age population with benefits: 9.0%
> Pct. with recurring neck and back pain: 39.0% (the highest)
> 2011 labor force participation rate: 54.1% (the lowest)
> 2011 unemployment rate: 7.8% (23rd lowest)

No state had a higher percentage of working age people receiving SSDI benefits than West Virginia. In addition, the benefits received from by the federal government were more generous compared to most states. The average monthly benefit of more than $1,140 in 2011 was the 10th highest of all states. Almost 21% of recipients received monthly benefits of at least $1,600, a higher percentage than all but three states. Like most states on this list, West Virginia is among the less-educated states in the country. Just 18.5% of the adult population had a bachelor’s degree, the lowest percentage of all states. Also, few residents in the state had jobs. Just 54.1% of residents were considered part of the labor force in 2011, by far the lowest percentage of any state in the nation.

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