More than two-thirds of all homicides in the United States are gun-related. Of the 16,121 homicides reported in 2013, 11,208 were caused by gun violence. Including suicides, nearly 34,000 people died in gun-related incidents in 2013, up 13.8% from 10 years earlier.

The Centers for Disease Control and Prevention (CDC) keeps track of the number of gun-related deaths in each state. Fatalities include homicides, suicides, and accidents. The frequency of firearm-related deaths varies considerably across the country. In Hawaii, the state with the fewest gun-related fatalities, there were just 2.6 firearm-associated deaths per 100,000 people. In Alaska, on the other hand, there were nearly 20 gun-related deaths per 100,000 residents, the most of any state. 24/7 Wall St. examined the 10 states with the highest gun-related deaths.

Click here to see the 10 states with the most gun violence. 

Suicide is the leading cause of gun-related deaths across the country in recent years. Of the 33,636 firearm deaths in 2013, more than 21,000 were suicides. In fact, suicide accounted for more than half of gun-related deaths in all but one state with the most gun violence. In three states — Alaska, Montana, and Wyoming — suicide accounted for more than 80% of all firearm deaths.

24/7 Wall St. discussed the CDC’s figures with John Roman, senior fellow at the Urban Institute, an economic and social policy think tank. Roman explained that states with the highest rates of suicide often have the strongest culture of gun ownership in the country. “There are many more suicides in places where it’s easy to get a gun,” he said.

While federal gun laws are uniform across the country, state regulations vary, offering more lax or more strict approaches to firearm use. Seven of the 10 states with the most firearm deaths in 2013 have enacted stand your ground laws. In keeping with a state’s culture, Roman explained, many states with these laws likely also have laws that make it easier to possess firearms and buy ammunition.

In fact, none of the states with the most gun violence require permits to purchase rifles, shotguns, or handguns. Gun owners are also not required to register their weapons in any of these states. Meanwhile, many of the states with the least gun violence require a permit or other form of identification to buy a gun.

Gun-related homicides were also relatively frequent in the states with the most gun violence. Nationally, there were 3.61 homicides per 100,000 people. Seven of the the 10 states with the most gun violence reported homicide rates higher than the national rate. Louisiana is one of only four states in the country where homicides accounted for a larger share of firearm deaths than suicides. In 2013, Louisiana reported nearly 10 homicides per 100,000 residents, the highest rate in the country.

Although not necessarily related, violent crime rates in the states with the most gun violence were also quite high. In fact, in seven of these states there were more than 430 violent crimes reported per 100,000 residents. Nationally, the rate was 367.9 violent crimes per 100,000 Americans.

Limited access to quality hospitals may be a contributing factor to firearm deaths. Often, victims of gunshots or other violent crimes need immediate medical attention, which may be more difficult to receive in rural areas. “If you have a hospital with a Level III trauma center, your likelihood of surviving an injury like a gunshot wound is far higher than if you lived near a basic hospital,” Roman said.

Economic factors also appear to be related to firearm deaths. The poverty rate in eight of the 10 states with the most gun violence was above the national rate of 15.8%. Mississippi, New Mexico, Louisiana, and Arkansas, the states with the four highest poverty rates in the country, were among the states with the most gun violence.

Educational attainment rates also tended to be lower in states with the most gun violence. The share of adults with at least a bachelor’s degree was lower than the national rate of 29.6% in all 10 states on this list.

To determine the states with the most gun violence, 24/7 Wall St. examined 2013 firearm-related deaths data from the CDC. Firearm death rates are age-adjusted to avoid distortion in states with large populations of young people. We also considered 2013 violent crime rates from the Federal Bureau of Investigation’s Uniform Crime Report. From the U.S. Census Bureau, we reviewed median household income, poverty rates, and educational attainment rates for 2013. Information on firearm policies for each state are from the National Rifle Association’s (NRA) Institute for Legislative Action.

These are the states with the most gun violence.

10. Tennessee
> 2013 firearm death rate: 15.4 per 100,000
> Total firearm deaths 2004-2013: 9,568 (11th highest)
> Violent crime rate: 590.6 (4th highest)
> Permit required to buy handgun: No
> Poverty rate: 17.8% (12th highest)

There were more than 1,000 gun-related deaths — including homicide, suicide, and accidents — in Tennessee in 2013, or 15.4 deaths per 100,000 residents, the 10th highest rate in the country. Overall crime rates were also quite high, with 590.6 violent crimes reported per 100,000 people, far more than the nearly 368 reported crimes for every 100,000 Americans. Additionally, less than 25% of adults in the state had at least a bachelor’s degree, less than the 29.6% of adults with a bachelor’s degree across the nation.

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9. New Mexico
> 2013 firearm death rate: 15.4 per 100,000
> Total firearm deaths 2004-2013: 2,983 (19th lowest)
> Violent crime rate: 613.0 (2nd highest)
> Permit required to buy handgun: No
> Poverty rate: 21.9% (2nd highest)

Like most states across the country, the largest proportion of gun-related deaths in New Mexico was attributable to suicide. The age-adjusted firearm suicide rate of 10.3 per 100,000 was the ninth highest rate in the country. New Mexico also had the highest death rate by legal intervention — deaths caused by police or other law enforcement officials — in the country. In general, New Mexico residents were exposed to a large number of crimes. The state reported 613 violent crimes per 100,000 residents, the second highest rate in the country. Low education levels and widespread poverty may partly explain the high gun violence and deaths. Nearly 22% of New Mexico’s population lived in poverty, substantially higher than the national poverty rate of 15.8%. Additionally, only 84.3% of adults had at least a high school diploma, the sixth lowest rate in the country.

8. Oklahoma
> 2013 firearm death rate: 16.5 per 100,000
> Total firearm deaths 2004-2013: 5,352 (23rd highest)
> Violent crime rate: 441.2 (12th highest)
> Permit required to buy handgun: No
> Poverty rate: 16.8% (16th highest)

Gun-related homicides and suicides were both relatively high in Oklahoma. At least 433 Oklahomans, or 11.1 per 100,000, took their own life with a gun, the sixth highest rate in the country. There were 4.8 gun-related homicides per 100,000 residents, the 10th highest rate nationwide. Like all of the states with the most gun violence, Oklahoma also does not require a permit to purchase a rifle, shotgun, or handgun. Additionally, Oklahoma households were among the poorest in the country with an annual median income of $45,690.

7. Wyoming
> 2013 firearm death rate: 16.5 per 100,000
> Total firearm deaths 2004-2013: 879 (7th lowest)
> Violent crime rate: 205.1 (4th lowest)
> Permit required to buy handgun: No
> Poverty rate: 10.9% (6th lowest)

With the second highest firearm-related suicide rate, Wyoming residents were more than twice as likely to commit suicide as residents across the nation. More than 87% of firearm deaths in Wyoming were due to suicide, considerably higher than the 63% of all gun-related fatalities across the country. Unlike other states with high rates of gun-violence, however, Wyoming residents were well-educated. Roughly 94% of adults 25 and older had at least graduated from high school, the highest rate in the country. Despite the high rate of gun-violence, other types of crimes were relatively uncommon. Just over 205 violent crimes were reported per 100,000 residents, one of the lowest rates in the country.

6. Arkansas
> 2013 firearm death rate: 16.7 per 100,000
> Total firearm deaths 2004-2013: 4,478 (24th lowest)
> Violent crime rate: 460.3 (10th highest)
> Permit required to buy handgun: No
> Poverty rate: 19.7% (4th highest)

A typical household in Arkansas earned $40,511 in 2013, nearly the lowest such figure in the country. Additionally, just 20.6% of adults had at least a bachelor’s degree, the third lowest rate nationwide. The low incomes and education levels may have contributed to Arkansas’ high gun-related deaths. There were 501 deaths by firearm in Arkansas, or 16.7 per 100,000, the sixth highest rate. Like other states in the country, nearly two-thirds of gun-related deaths were due to suicide. Like every state on this list, Arkansas’ gun laws are relatively permissive. Currently, no laws require that gun owners have permits for the purchase of shotguns, rifles, and handguns. Additionally, gun owners are not obligated to register their weapons.

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5. Montana
> 2013 firearm death rate: 16.8 per 100,000
> Total firearm deaths 2004-2013: 1,540 (12th lowest)
> Violent crime rate: 252.9 (11th lowest)
> Permit required to buy handgun: No
> Poverty rate: 16.5% (19th highest)

Montana had the fifth highest rate of firearm deaths, at nearly 17 per 100,000 residents. Further, gun-related deaths have been steadily increasing since 2006. In fact, Montana registered the highest firearm death rate in the decade ending in 2013. Other types of crime — including rape, robbery, and motor vehicle theft — were relatively less common in the state. There were roughly 253 violent crimes per 100,000 residents, significantly lower than the violent crime rate across the nation of nearly 368 per 100,000. As in many of the states with high rates of gun deaths, suicides made up the vast majority of deaths. More than 85% of gun-deaths were due to suicide, the 10th highest such share in the country.

4. Alabama
> 2013 firearm death rate: 17.5 per 100,000
> Total firearm deaths 2004-2013: 7,915 (16th highest)
> Violent crime rate: 430.8 (14th highest)
> Permit required to buy handgun: No
> Poverty rate: 18.7% (7th highest)

Nearly 19% of Alabama residents lived below the poverty line, the seventh highest rate in the country. Additionally, the state had among the worst educational attainment rates nationwide, which may have contributed to the high gun-death rate. Between 2004 and 2013, an annual average of 16.6 people were killed by firearms, the fourth highest rate in the country. Despite a drop in 2011, the firearm death rate increased to the state’s 10-year high in 2013. Other types of crime in Alabama were also prevalent. There were 430.8 violent crimes reported per 100,000, a higher rate than the 367.9 violent crimes across the nation.

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3. Mississippi
> 2013 firearm death rate: 17.7 per 100,000
> Total firearm deaths 2004-2013: 5,056 (24th highest)
> Violent crime rate: 274.6 (18th lowest)
> Permit required to buy handgun: No
> Poverty rate: 24.0% (the highest)

With 24% of its residents living in poverty, Mississippi had the highest poverty rate in the country. Poverty and low educational attainment rates may contribute to higher rates of gun-related deaths. Mississippi had the second highest gun-related homicide rate in the country at 7.4 homicides per 100,000 residents. In general, crime was not particularly prevalent. There were just 274.6 violent crimes reported per 100,000, compared with 367.9 such crimes per 100,000 across the country. Mississippi also led the country in unintentional deaths by a firearm, with 0.6 deaths occurring for every 100,000 people, three-times more frequent than across the country.

2. Louisiana
> 2013 firearm death rate: 19.1 per 100,000
> Total firearm deaths 2004-2013: 8,552 (13th highest)
> Violent crime rate: 518.5 (5th highest)
> Permit required to buy handgun: No
> Poverty rate: 19.8% (3rd highest)

Louisiana was the only state with the most gun violence where firearm-related suicides accounted for less than half of all gun deaths. In fact, homicides accounted for roughly 51% of all gun deaths in the state. As a result, Louisiana had the highest gun-related homicide rate in the country, at 9.7 murders per 100,000 residents. Louisiana also had the highest average firearm death rate in the country over the 10 years ending in 2013, when there were 18.8 firearm deaths per 100,000 in the state, compared with 10.2 across the country. The high number of gun deaths may be tied to gun policy. Louisiana, like many of the states on this list, does not require gun owners to have a permit to purchase a firearm, nor must they register their weapons.

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1. Alaska
> 2013 firearm death rate: 19.6 per 100,000
> Total firearm deaths 2004-2013: 1,256 (10th lowest)
> Violent crime rate: 640.4 (the highest)
> Permit required to buy handgun: No
> Poverty rate: 9.3% (2nd lowest)

There were roughly 20 firearm deaths per 100,000 residents in Alaska, nearly double the national rate. As in many other states with high gun-death rates, the vast majority of deaths were the result of suicide. Unlike most states on this list, however, Alaskan households were quite wealthy. A typical household earned $72,237, roughly $20,000 more than a typical household across the nation. Other types of crime were also more common in the state. In fact, Alaska had the highest violent crime rate in the country at more than 640 violent crimes per 100,000 residents.

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