The leading causes of death tend to be the same across the country. A majority of deaths are due to heart disease, followed by cancer and chronic lower respiratory disease. However, some causes of death affect some state residents far more than others.

The Centers for Disease Control and Prevention (CDC) recently released a report, “The Most Distinctive Causes of Death by State, 2001-2010,” detailing causes of death most out of proportion to national rates. In some states, the results are intuitive. In others, unusually common causes of death are much more surprising.

Click here to see the most unusual cause of death in each state

The data in this report is particularly interesting because it highlights both issues with “standard” reporting systems and significant disparities in various causes of death by state. Several states, most notably Maryland and Utah, frequently use vague, catch-all categories, like death from “events of undetermined intent,” which make it difficult to draw conclusions.

Some of the results are startling: Hawaiian residents, who live in one of the most fertile states in the country, are three times more likely than their fellow Americans to die of nutritional deficiencies. In Louisiana, deaths from syphilis, an easily treatable and preventable infection, are five times the national rate.

There are also some more predictable outcomes. Deaths from influenza are far more likely in the colder Northern states. And mortality from respiratory diseases, like “black lung,” is more prevalent in states like Kentucky and West Virginia, where mining is still a significant industry. West Virginia, in fact, has a mortality rate over twelve times the national average from such diseases.

Based on the methodology described in “The Most Distinctive Causes of Death by State” report, 24/7 Wall St. identified the most unusual causes of death by state. We relied on data from the CDC’s epidemiology database, which stores the coded causes of death as reported to each state. These codes, referred to as ICD codes, provide a standard way for diseases, symptoms, and other health-related data to be referenced and recorded. They are used internationally for morbidity and mortality statistics, reimbursement systems, and other automated health care decisions, such as whether or not an insurance company will pay for a medical test.

We computed the ratio of age-adjusted mortality rates for states compared to the national average using the data provided by CDC WONDER. This dataset includes the raw number of deaths over a given time period, the population at risk, and then computes a crude and age-adjusted mortality rate when there are 20 or more deaths in the category. Thus, the ratio is simply the age-adjusted mortality rate for the state divided by the age-adjusted mortality rate for the nation in each individual category.

While the report published by Dr. Francis P. Boscoe and Eva Pradhan provides an age-adjusted mortality rate for each state, 24/7 Wall St. was unable to calculate an age-adjusted mortality rate for 10 states due to insufficient sample size.

In addition to data cited in Dr. Boscoe’s report, we also considered the percent of adults who have smoked at least 100 cigarettes in their lifetime and percent of residents who could not see a doctor because of costs from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. The percent of adults who were obese in 2013 and firearm death rate per 100,000 for 2013 also come from the CDC. From the U.S. Census Bureau’s 2013 American Community Survey, we considered portion of the population without health insurance and poverty rate. Percent of the population with limited access to healthy food in 2012 came from the United States Department of Agriculture. From County Health Rankings & Roadmaps, we used data on the number of residents per primary care physician.

These are the most unusual causes of death in each state and the District of Columbia.

1. Alabama
> Cause of death: Accidental discharge of firearms
> No. deaths 2001-2010: 348
> Age-adjusted mortality rate: 0.77 per 100,000
> Mortality rate compared to national: 3.5

The ICD code for “accidental discharge of firearms” clearly does not cover all forms of death caused by a gun, but it also does not cover all accidental deaths caused by gunfire. Several other categories, including “other and unspecified nontransport accidents,” “discharge of firearms, undetermined intent,” include these types of accidents. Despite this drawback in this sort of determination, Alabama’s age-adjusted mortality rate from accidental discharge of firearms is 3.5 times higher than the national rate. Ten other states (Arkansas, Kentucky, Louisiana, Mississippi, Montana, South Carolina, South Dakota, Tennessee, West Virginia, and Wyoming) have rates at least twice the national average, with the largest difference represented by Louisiana’s 3.9.

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2. Alaska
> Cause of death: Water, air and space, and other and unspecified transport accidents
> No. deaths 2001-2010: 270
> Age-adjusted mortality rate: 4.1 per 100,000
> Mortality rate compared to national: 6.7

Transportation in Alaska is not easy. It is a massive state, covering an area roughly one-fifth the size of all 48 lower states. Much of the state is inaccessible by roads, and people need to rely on sea and air transportation to move great distances. It is understandable, then, that the mortality rate from accidents related to these forms of travel would be much higher in Alaska than the rest of the U.S. In fact, this cause of death is 6.7 times higher than the national average. Similarly, mortality related to “accidental drowning and submersion” is 3.3 times higher than the rate nationwide.

3. Arizona
> Cause of death: Discharge of firearms, undetermined intent
> No. deaths 2001-2010: 147
> Age-adjusted mortality rate: 0.25 per 100,000
> Mortality rate compared to national: 2.8

Like Alabama, this category only covers some gun deaths. In Arizona, this cause of death is reported 2.8 times more frequently than the national average. Four other states (Alaska, Arkansas, Mississippi, and Tennessee) are at least twice the national average, led by Alaska’s 5.7.

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4. Arkansas
> Cause of death: Discharge of firearms, undetermined intent
> No. deaths 2001-2010: 73
> Age-adjusted mortality rate: 0.28 per 100,000
> Mortality rate compared to national: 3.1

Arkansans are 3.1 times more likely to die from this reported cause of death compared to the national average. Arkansas also has the fifth highest firearm death rate in the country according to the CDC. In 2013, there were 16.8 gun deaths per 100,000 people, just below Alaska, Louisiana, Mississippi, and Alabama.

 

5. California
> Cause of death: Hyperplasia of prostate
> No. deaths 2001-2010: 937
> Age-adjusted mortality rate: 0.3 per 100,000
> Mortality rate compared to national: 2.0

“Hyperplasia of prostate” refers to “a benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine.” This is commonly referred to as BPH. Californians are twice as likely to die from this than people in the nation as a whole. Vermont (3.0) and the District of Columbia (2.2) have similarly high ratios. The age-adjusted mortality rate from this cause of death in California is 0.3 per 100,000, and likely represents consequences of surgery to treat BPH, or urinary tract infections and renal failure secondary to long-term or poorly treated disease.

6. Colorado
> Cause of death: Atherosclerosis
> No. deaths 2001-2010: 3,457
> Age-adjusted mortality rate: 9.21 per 100,000
> Mortality rate compared to national: 2.7

Atherosclerosis in general refers to a disorder of circulation where arteries become hardened and thickened, restricting the flow of blood. This listed cause of death refers specifically to atherosclerosis of the aorta (the largest artery in the body), the renal arteries (which bring blood to the kidneys), and the arteries that supply blood to the extremities. In Colorado, the mortality rate from atherosclerosis is 2.7 times higher than the national average, with an age-adjusted mortality rate of 9.2 per 100,000. Two other states, Kansas (3.1) and Nevada (2.1) have similarly high rates. Atherosclerosis is more likely in people who smoke, have high blood pressure, high cholesterol, and limited exercise.

7. Connecticut
> Cause of death: Inflammatory diseases of female pelvic organs
> No. deaths 2001-2010: 19
> Age-adjusted mortality rate: N/A
> Mortality rate compared to national: N/A

This category includes infections and other inflammatory conditions of the female reproductive tract, excluding the vast majority of sexually transmitted infections. With only 19 deaths reported, 24/7 Wall St. did not calculate an age-adjusted mortality rate for the state due to generally poor data reliability. Two states, Alabama and New York, both have age-adjusted mortality rates from these processes that are twice the national average.

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8. Delaware
> Cause of death: Atherosclerotic cardiovascular disease
> No. deaths 2001-2010: 3,299
> Age-adjusted mortality rate: 36.5 per 100,000
> Mortality rate compared to national: 1.8

Atherosclerosis refers to the thickening and hardening of arteries in the body. Atherosclerotic cardiovascular disease refers to this process occurring in the heart, and is by far the most common cause of heart attacks. Delaware is a very average state in terms of disease mortality, with its greatest discrepancy only 1.8 times higher than the national average. The highest reported rate of mortality from atherosclerotic cardiovascular disease in any state is only 2.2 times higher than the national average, which was reported by Maryland. The District of Columbia, however, has a rate 4.9 times higher.

9. District of Columbia
> Cause of death: Human immunodeficiency virus
> No. deaths 2001-2010: 1,977
> Age-adjusted mortality rate: 34.43 per 100,000
> Mortality rate compared to national: 8.6

The human immunodeficiency virus, or HIV, is the virus that leads to the development of AIDS. In the District of Columbia, the rate of death from this disease is reported as 8.6 times higher than the age-adjusted mortality rate in the nation. D.C. is an unfortunately unhealthy city, with mortality rates at least three-times higher than the national average in tuberculosis, hypertensive heart disease, hypertensive heart and renal disease, atherosclerotic cardiovascular disease, and assault (by gun and otherwise).

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10. Florida
> Cause of death: Human immunodeficiency virus
> No. deaths 2001-2010: 15,563
> Age-adjusted mortality rate: 8.75 per 100,000
> Mortality rate compared to national: 2.2

HIV has a 2.2 times higher age-adjusted mortality rate in Florida than in the rest of the country. Florida is otherwise an average state when it comes to causes of death, with no other causes reported above twice the national rate. The higher mortality rate for HIV in Florida may be related to the relatively poor access to health care in the state compared to the rest of the nation, as it has become more of a long-term treated disease when patients have access to proper medication and health care. As of 2013, Florida had the third-highest uninsured rate (20%), and ninth-highest rate of people who could not afford to see a doctor (16.7%).

11. Georgia
> Cause of death: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
> No. deaths 2001-2010: 18,434
> Age-adjusted mortality rate: 25.66 per 100,000
> Mortality rate compared to national: 2.3

This classification is a catch-all, and likely a sign of poor reporting either by physicians on death certificates or by the state in filling out forms. This “cause” of death can include anything from cough, to an abnormal heart rate, to “abnormal findings on diagnostic imaging,” to the final catch-all “ill-defined and unknown cause of mortality.” In Georgia, this code is the age-adjusted cause of mortality in 25.7 deaths per 100,000, or 2.3 times the national average. Five other states (Alabama, Minnesota, Nebraska, Nevada, and Utah), and the District of Columbia also have rates more than twice the national average in this category.

12. Hawaii
> Cause of death: Other nutritional deficiencies
> No. deaths 2001-2010: 26
> Age-adjusted mortality rate: 0.18 per 100,000
> Mortality rate compared to national: 3.0

“Other nutritional deficiencies” is a categorical code used for deaths due to poor intake or absorption of vitamins, minerals, or calories. In Hawaii, the age-adjusted mortality rate attributed to this cause is only 0.18 per 100,000, but this is three times the national average. Interestingly, Hawaiians have relatively good access to healthy food, ranking 22nd overall with only 5.8% of residents having limited access, according to data from the USDA.

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13. Idaho
> Cause of death: Water, air and space, and other and unspecified transport
> No. deaths 2001-2010: 207
> Age-adjusted mortality rate: 1.42
> Mortality rate compared to national: 2.3

Idaho is an average state in terms of mortality data, with only this category being more than twice (2.3) the national average. Montana and Alaska are the only two other states with similarly high rates. At 207 reported deaths between 2001 and 2010, this accounted for an age-adjusted mortality rate of 1.42 per 100,000, which is still much lower than the state’s mortality rate for motor vehicle accidents (18.46).

14. Illinois
> Cause of death: Other disorders of kidney
> No. deaths 2001-2010: 12
> Age-adjusted mortality rate: N/A
> Mortality rate compared to national: N/A

“Other disorders of kidney” is a categorical grouping for several less common kidney disorders. The 12 deaths accounts for an incredibly low percentage of total deaths reported in Illinois from 2001 to 2010 (0.0005%). Illinois is an average state in terms of overall causes of death, with no other categories more than 1.4 times the national average.

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15. Indiana
> Cause of death: Other and unspecified events of undetermined intent
> No. deaths 2001-2010: 1,717
> Age-adjusted mortality rate: 2.77 per 100,000
> Mortality rate compared to national: 1.8

This category refers to deaths due to some injury where there is specific documentation that the intent of the injury cannot be determined. These include fires, explosions, falls, etc. In Indiana, this category has an age-adjusted mortality rate that is 1.8 times higher than the national average, accounting for 2.77 deaths per 100,000.

16. Iowa
> Cause of death: Other and unspecified acute lower respiratory infections
> No. deaths 2001-2010: 26
> Age-adjusted mortality rate: 0.06 per 100,000
> Mortality rate compared to national: 3.0

Other and unspecified acute lower respiratory infections refers to lung infections with no specific cause or type (e.g. not a bacterial or viral pneumonia, not a bronchitis, etc.). With a very low number of deaths, this is likely not particularly statistically significant. The age-adjusted mortality rate for this category is three times higher in Iowa than in the rest of the country. Five other states (Kansas, Minnesota, Nebraska, Ohio, and Wisconsin) report rates at least twice the national average. The vast majority of states, simply do not have enough deaths reported in this category to even reliably measure.

17. Kansas
> Cause of death: Other and unspecified acute lower respiratory infections
> No. deaths 2001-2010: 46
> Age-adjusted mortality rate: 0.15 per 100,000
> Mortality rate compared to national: 7.5

In Kansas, the mortality rate is 7.5 times higher than the national average, but still only accounts for 0.15 deaths per 100,000. Only atherosclerosis and “other acute lower respiratory infections” (a broader category which includes the processes in the above grouping) also have rates in Kansas that are more than twice the national average.

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18. Kentucky
> Cause of death: Pneumoconioses and chemical effects
> No. deaths 2001-2010: 449
> Age-adjusted mortality rate: 1.04 per 100,000
> Mortality rate compared to national: 3.3

Pneumoconiosis is a restrictive lung disease caused by the inhalation of dust. It is better known as “black lung” and most frequently associated with coal workers. Small particulate matter, like coal dust, when inhaled into the lungs, cannot be coughed out or absorbed. Instead, the body builds a wall of inflammatory tissue around the particles, and over time this leads to a significant restriction in the ability to exchange oxygen and carbon dioxide in the lungs. These processes have a reported age-adjusted mortality rate in Kentucky that is 3.3 times higher than the national average.

19. Louisiana
> Cause of death: Syphilis
> No. deaths 2001-2010: 22
> Age-adjusted mortality rate: 0.05 per 100,000
> Mortality rate compared to national: 5.0

Syphilis is a bacterial infection generally spread through sexual contact and is one of the more common sexually transmitted infections. It is easily prevented with safe sex practices, and similarly easy to treat if caught early. Unfortunately, when the disease goes untreated, it can lead to severe organ damage and eventually death. As of 2013, Louisiana had the third-highest poverty rate in the country, the sixth-highest rate of people who couldn’t afford a doctor’s visit, and the 10th-lowest rate of people with a primary care physician. As with most readily treatable infections, those without access to care are more likely to suffer the consequences. In Louisiana, the mortality rate from syphilis is five times higher than the national rate, but still only 0.05 deaths per 100,000.

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20. Maine
> Cause of death: Influenza
> No. deaths 2001-2010: 154
> Age-adjusted mortality rate: 0.99 per 100,000
> Mortality rate compared to national: 2.6

The flu is a virus that spreads rapidly through the air from one person to another, and “flu season” coincides with winter. In cold weather, researchers have found that the virus forms a special outer coating that helps it float through the air, aiding in transmission. Maine, as with many other Northern states, has a 2.6 times higher mortality rate from the flu than the national average.

21. Maryland
> Cause of death: Other and unspecified events of undetermined intent
> No. deaths 2001-2010: 6,588
> Age-adjusted mortality rate: 11.47 per 100,000
> Mortality rate compared to national: 7.3

Maryland is one of several states whose most disproportionate cause of death is the non-specific trauma or injury. The mortality rate from this is 7.3 times higher in Maryland than the national average. “Events of undetermined intent” are the second most disproportionate in the state, and seven times higher than the national average. Atherosclerotic cardiovascular disease and HIV are the only other two causes of death more than twice the national average in Maryland.

22. Massachusetts
> Cause of death: Other and unspecified events of undetermined intent
> No. deaths 2001-2010: 3,077
> Age-adjusted mortality rate: 4.72 per 100,000
> Mortality rate compared to national: 3.0

Massachusetts is a very average state in terms of causes of death, with only vaguely defined accident-category codes reporting mortality rates more than twice the national average. “Other and unspecified events of undetermined intent” accounts for an age-adjusted 4.72 deaths per 100,000; its parent category, “events of undetermined intent” accounts for an age-adjusted 4.75 deaths per 100,000.

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23. Michigan
> Cause of death: Atherosclerotic cardiovascular disease, so described
> No. deaths 2001-2010: 37,292
> Age-adjusted mortality rate: 35 per 100,000
> Mortality rate compared to national: 1.7

Typical heart disease accounted for 35 age-adjusted deaths per 100,000 in Michigan, which is 1.7 times higher than the national average. The state is otherwise average in terms of its causes of death. Michigan has the 10th-highest rate of obesity and 14th-highest poverty rate, but has relatively low rates of uninsured residents (11%, or 14th best).

24. Minnesota
> Cause of death: Other and unspecified acute lower respiratory infections
> No. deaths 2001-2010: 28
> Age-adjusted mortality rate: 0.05 per 100,000
> Mortality rate compared to national: 2.5

As with Iowa and Kansas, Minnesota has a significantly higher mortality rate from these non-specific lung infections than the national average. In Minnesota, this rate is 2.5 times higher than the national average. Mortality rates from influenza (2.1) and the very general catch-all category, “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified,” are similarly elevated.

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25. Mississippi
> Cause of death: Other and unspecified malignant neoplasms of lymphoid, hematopoietic and related tissue
> No. deaths 2001-2010: 18
> Age-adjusted mortality rate: N/A
> Mortality rate compared to national: N/A

This category refers to poorly classified cancers of the blood and immune system, and accounts for such a small number of deaths that 24/7 Wall St. was unable to compute independently age-adjusted mortality rates. Age-adjusted mortality rates are generally higher in Mississippi, with several categories more than twice the national average: hypertensive heart disease (2.3), hypertensive heart and renal disease (2.5), heart failure (2.6), motor vehicle (2.1) and transport accidents (2.0).

26. Missouri
> Cause of death: Meningococcal infection
> No. deaths 2001-2010: 31
> Age-adjusted mortality rate: 0.05 per 100,000
> Mortality rate compared to national: 1.7

Meningococcal infections are one of the most common and deadly causes of meningitis, an infection of the covering of the brain. There are occasional outbreaks of this infection on college campuses and other institutions, leading to the widespread use of the meningococcal vaccine in teenagers. In Missouri, the age-adjusted mortality rate for meningococcal infection is 1.7 times higher than the national average. Five other states (Iowa, Louisiana, Oklahoma, Oregon, and Washington) have rates at least twice the national average.

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27. Montana
> Cause of death: Acute and rapidly progressive nephritic and nephrotic syndrome
> No. deaths 2001-2010: 11
> Age-adjusted mortality rate: N/A
> Mortality rate compared to national: N/A

These are a collection of syndromes and diseases that lead to rapid kidney failure, and if not properly treated with supportive care (frequently requiring dialysis) and reversal of the disease processes, can cause death. There are too few deaths from this category for 24/7 Wall St. to compute independently an age-adjusted mortality rate for Montana; three other states (Arkansas, New Mexico, and Oregon) have rates at least twice the national average.

28. Nebraska
> Cause of death: Other and unspecified acute lower respiratory infections
> No. deaths 2001-2010: 32
> Age-adjusted mortality rate: 0.14 per 100,000
> Mortality rate compared to national: 7.0

The mortality rate from these lung infections is seven times higher in Nebraska than in the rest of the country, but still only accounts for 0.14 deaths per 100,000. Mortality rates in the state for “other lower respiratory infections” and “symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified” are also more than twice the national average.

29. Nevada
> Cause of death: Legal intervention
> No. deaths 2001-2010: 82
> Age-adjusted mortality rate: 0.34 per 100,000
> Mortality rate compared to national: 2.8

Deaths due to “legal intervention” are caused by any injury sustained in an encounter with law enforcement officials, serving in any capacity at the time of the encounter, whether on-duty or off-duty. The age-adjusted mortality rate for this category is 2.8 times higher than the national average. Mortality rates for atherosclerosis and “symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified” are also more than twice the national average.

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30. New Hampshire
> Cause of death: Other nutritional deficiencies
> No. deaths 2001-2010: 14
> Age-adjusted mortality rate: N/A
> Mortality rate compared to national: N/A

The number of deaths from this category were too low for 24/7 Wall St. compute an age-adjusted mortality rate independently. Nutritional deficiencies refer to inadequate intake or absorption of important vitamins and minerals. New Hampshire is an otherwise average state in terms of causes of mortality, with only mildly increased rates of digestive tract infections that are 1.7 times the national average.

31. New Jersey
> Cause of death: Septicemia
> No. deaths 2001-2010: 18,353
> Age-adjusted mortality rate: 19.41 per 100,000
> Mortality rate compared to national: 1.7

Septicemia refers specifically to the presence of bacteria or their toxins in the blood, but also includes “sepsis,” which is a clinical diagnosis of a systemic inflammatory process with some known infectious source. The age-adjusted mortality rate for septicemia in New Jersey is 1.7 times higher than the national average. This results in roughly 19.41 deaths per 100,000.

32. New Mexico
> Cause of death: Legal intervention
> No. deaths 2001-2010: 77
> Age-adjusted mortality rate: 0.42 per 100,000
> Mortality rate compared to national: 3.5

The age-adjusted mortality rate for “legal intervention” in New Mexico is 3.5 times higher than the national average. In addition to New Mexico, only Nevada, Oklahoma and Oregon are states where this rate is more than twice the national average.

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33. New York
> Cause of death: Inflammatory diseases of female pelvic organs
> No. deaths 2001-2010: 97
> Age-adjusted mortality rate: 0.06 per 100,000
> Mortality rate compared to national: 2.0

The age-adjusted mortality rate for this category is twice the national average. The mortality rate from HIV in New York is also approximately twice the national average and accounts for a much more significant 7.83 deaths per 100,000. The state is otherwise average in terms of causes of death.

34. North Carolina
> Cause of death: Other nutritional deficiencies
> No. deaths 2001-2010: 103
> Age-adjusted mortality rate: 0.11 per 100,000
> Mortality rate compared to national: 1.8

The age-adjusted mortality rate for “other nutritional deficiencies” in North Carolina is only 1.8 times the national average; the state is otherwise average in terms of causes of death.

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35. North Dakota
> Cause of death: Influenza
> No. deaths 2001-2010: 83
> Age-adjusted mortality rate: 1 per 100,000
> Mortality rate compared to national: 2.6

As with many other Northern states, the age-adjusted rate of mortality from the flu is significantly higher than the national average, accounting for 1 death per 100,000. The state is otherwise relatively average with regards to causes of death.

36. Ohio
> Cause of death: Other and unspecified acute lower respiratory infections
> No. deaths 2001-2010: 73
> Age-adjusted mortality rate: 0.05 per 100,000
> Mortality rate compared to national: 2.5

Ohio is similar to several of its Midwestern neighbors with higher age-adjusted rates of mortality from “other and unspecified acute lower respiratory infections” (2.5) and “other acute lower respiratory infections” (2.0), but is otherwise unremarkable regarding causes of death.

37. Oklahoma
> Cause of death: Other acute ischemic heart diseases
> No. deaths 2001-2010: 8,623
> Age-adjusted mortality rate: 22.73 per 100,000
> Mortality rate compared to national: 19.4

With an age-adjusted mortality rate 19.4 times higher than the national average, Oklahoma holds the record for largest discrepancy in a category determining cause of death. This category generally refers to damage to the heart that does not lead to a full myocardial infarction or “heart attack.” This would generally be less likely to result in death. In Oklahoma, this category accounts for an age-adjusted mortality rate of 22.7 per 100,000. South Carolina (3.9) and Virginia (5.9) are the only other two states with rates more than twice the national average.

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38. Oregon
> Cause of death: Legal intervention
> No. deaths 2001-2010: 110
> Age-adjusted mortality rate: 0.32 per 100,000
> Mortality rate compared to national: 2.7

The mortality rate for legal intervention in Oregon is 2.7 times higher than the national average. Meningococcal infections and “acute and rapidly progressive nephritic and nephrotic syndrome” are the only other two categories in the state with an age-adjusted mortality rate at least twice the national average.

39. Pennsylvania
> Cause of death: Pneumoconioses and chemical effects
> No. deaths 2001-2010: 1,470
> Age-adjusted mortality rate: 0.89 per 100,000
> Mortality rate compared to national: 2.8

Deaths from this category, also known as “miner’s lung,” are 2.8 times more likely to be reported in Pennsylvania than in the rest of the country. While more famous for its steel mills, mining is still a significant activity in Pennsylvania. Both these industries carry a risk of chemical damage to the lungs, with a disease called siderosis in steelworkers secondary to inhaled iron oxide.

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40. Rhode Island
> Cause of death: Other and unspecified events of undetermined intent
> No. deaths 2001-2010: 589
> Age-adjusted mortality rate: 5.6 per 100,000
> Mortality rate compared to national: 3.6

The mortality rate for this category is 3.6 times higher than the national average in Rhode Island; similarly, the mortality rate for “events of indeterminate intent” is 3.4 times above the national average. Otherwise, two gastrointestinal categories, “enterocolitis due to Clostridium difficile,” a serious bacterial infection, and “certain other intestinal infections” have rates more than twice the national average.

41. South Carolina
> Cause of death: Other acute ischemic heart diseases
> No. deaths 2001-2010: 2,094
> Age-adjusted mortality rate: 4.62 per 100,000
> Mortality rate compared to national: 3.9

These “other acute ischemic heart diseases” are less commonly associated with mortality than the typical myocardial infarctions and other major ischemic diseases to the heart. In fact, despite being nearly four times higher than the national rate, the age-adjusted mortality rate for this category in South Carolina is still only 1.7% of deaths from major cardiovascular diseases.

42. South Dakota
> Cause of death: Influenza
> No. deaths 2001-2010: 141
> Age-adjusted mortality rate: 1.46 per 100,000
> Mortality rate compared to national: 3.8

The mortality rate from influenza is 3.8 times higher in South Dakota than the national average, similarly elevated compared to other dry, Northern states. In addition to flu, the age-adjusted mortality rate for accidental discharge of firearms is 2.4 times higher than the national average.

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43. Tennessee
> Cause of death: Accidental discharge of firearms
> No. deaths 2001-2010: 336
> Age-adjusted mortality rate: 0.55 per 100,000
> Mortality rate compared to national: 2.5

“Accidental discharge of firearms” (2.5) and “discharge of firearms, undetermined event” (2.4) are both more than twice the national average in terms of age-adjusted mortality rate, accounting for a combined 0.77 deaths per 100,000 in Tennessee. Also at 2.5 times the national average, “infections of kidney” have an age-adjusted mortality rate of 0.58.

44. Texas
> Cause of death: Tuberculosis
> No. deaths 2001-2010: 679
> Age-adjusted mortality rate: 0.33 per 100,000
> Mortality rate compared to national: 1.7

Tuberculosis (TB) is a bacterial infection endemic to most of the world, present in roughly one-third of the world’s population and accounting for the second most deaths due to infectious disease after HIV. However, TB rates are generally low in the U.S. and other developed countries, due to aggressive treatment, proper quarantine, and hygiene techniques. In Texas, however, the mortality rate from tuberculosis is 1.7 times the national average. Only Alaska (4.0) and the District of Columbia (3.3) have rates more than twice the national average.

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45. Utah
> Cause of death: Other and unspecified events of undetermined intent
> No. deaths 2001-2010: 2,380
> Age-adjusted mortality rate: 10.3 per 100,000
> Mortality rate compared to national: 6.6

Various categories related to accidents — “other and unspecified events of undetermined intent” and “events of undetermined intent” — have significantly higher (more than six times) age-adjusted mortality rates in Utah than in other states. While several of the “accidental” death categories — “accidental discharge of firearms,” ”accidental drowning and submersion,” “accidental exposure to smoke, fire, and flames,” and “accidental poisoning and exposure to noxious substances” — are reported at significantly lower rates than average.

46. Vermont
> Cause of death: Other nutritional deficiencies
> No. deaths 2001-2010: 16
> Age-adjusted mortality rate: N/A
> Mortality rate compared to national: N/A

24/7 Wall St. could not determine the age-adjusted mortality rate for “other nutritional deficiencies” due to the low total number of deaths. However, death rates from influenza, hernia, “hyperplasia of prostate, and falls are at least twice twice the national average.

47. Virginia
> Cause of death: Other acute ischemic heart diseases
> No. deaths 2001-2010: 5,136
> Age-adjusted mortality rate: 6.92 per 100,000
> Mortality rate compared to national: 5.9

The age-adjusted mortality rate for this category is 5.9 times higher than the national average. The only other category significantly higher is “pneumoconioses and chemical effects” (2.7). Along with Oklahoma and South Carolina, the state also reports deaths from “other acute ischemic heart diseases” at significantly higher rates than others.

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48. Washington
> Cause of death: Meningococcal infection
> No. deaths 2001-2010: 47
> Age-adjusted mortality rate: 0.08 per 100,000
> Mortality rate compared to national: 2.7

The rate of mortality due to meningococcal infection is 2.7 times higher than the national average in Washington; this, however accounts for an incredibly small total number of deaths. The second most disparate cause of death in Washington state is Alzheimer’s, which at 1.8 times the national average has the highest rate in the country, and accounts for 41.2 deaths per 100,000.

49. West Virginia
> Cause of death: Pneumoconioses and chemical effects
> No. deaths 2001-2010: 882
> Age-adjusted mortality rate: 3.94 per 100,000
> Mortality rate compared to national: 12.3

The mortality rate due to pneumoconioses and chemical effects, also known as “black lung,” in West Virginia is 12.3 times higher than the national average, and accounts for an age-adjusted 3.9 deaths per 100,000. This is the second most disproportionate cause of death in the nation. This is likely due to the significant mining in the state, with the West Virginia Office of Miners’ Health, Safety and Training reporting roughly 30,000 direct jobs from the coal industry. Additionally, West Virginia has the highest rate of smoking in the nation.

Companies With the Best (and Worst) Reputations

50. Wisconsin
> Cause of death: Other and unspecified acute lower respiratory infections
> No. deaths 2001-2010: 26
> Age-adjusted mortality rate: 0.04 per 100,000
> Mortality rate compared to national: 2.0

Another average state in terms of causes of death, Wisconsin has three categories with age-adjusted mortality rates that are roughly twice the national average: “other and unspecified acute lower respiratory infections,” influenza, and falls. This fits a pattern seen in other Northern/Midwestern states, with the flu and lung infections being slightly more disproportionately represented.

51. Wyoming
> Cause of death: Influenza
> No. deaths 2001-2010: 49
> Age-adjusted mortality rate: 0.95 per 100,000
> Mortality rate compared to national: 2.5

The flu accounts for 0.95 deaths per 100,000 in Wyoming, the fourth highest ratio for age-adjusted mortality in the nation. Wyoming also has the second-highest age-adjusted mortality rate for intentional self-harm (suicide) by discharge of firearms, and third-highest for intentional self-harm overall — Alaska and Montana, round out the top three. All three states are at roughly twice the national average in both of these categories.

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