Life expectancy in the United States has fallen for two straight years, the first time this has occurred in more than half a century. The cause of this alarming trend is the sharp rise in opioid deaths, which have outpaced length of life gains from medical advancements. On average, Americans born today can expect to live 78.6 years. Residents of the United States who die before 75 are said to have died prematurely.

Hundreds of thousands of Americans die prematurely every year from accidents, curable disease, suicide, murder, drug overdose and other preventable causes.

Deaths from accidental injury, which includes the over 50,000 Americans who died from opioid overdoses last year, as well as traffic fatalities, are one of the leading causes of death in the United States. While lives are frequently cut short by accidents, suicide, and drug misuse — sometimes called deaths of despair — most premature deaths occur as a consequence of long-term unhealthy behaviors, poor access to medical care, and other conditions. Over time these risk factors can lead to common causes of death including heart disease, lung cancer, and diabetes.

Rather than treating them as separate problems, premature deaths from accidents and those from cancer and heart disease are actually closely related. Carol Graham, a senior fellow at the Brookings Institution who has written extensively on the subject of premature mortality in America, told 24/7 Wall St. that the population at risk of accidents are the same group that abuse their bodies over years and die of disease well before reaching old age.

“While [cancer and heart disease] can be differentiated from deaths of despair, the underlying cause — the reality of the economic situation for a large segment of the nation’s population — is the same for many who engage in this behavior. In addition to being more likely to abuse opioids, they are more likely to smoke, and to become obese, two of the most common causes of premature death. ” she said.

Using premature mortality figures collected by the Centers for Disease Control in its WONDER database, 24/7 wall st. ranked all 50 states based on the rate of residents who die before the age of 75.

Click here to see the states with the most premature death.
Click here to see our detailed findings and methodology.

50. Minnesota
> Deaths before age 75: 263.1 per 100,000 residents
> Vehicle fatalities: 7.1 per 100,000 residents (5th lowest)
> Drug overdose fatalities: 12.5 per 100,000 residents (11th lowest)
> Adult smoking rate: 15.2% (14th lowest)
> Adult obesity rate: 27.3% (18th lowest)

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49. Connecticut
> Deaths before age 75: 268.3 per 100,000 residents
> Vehicle fatalities: 8.2 per 100,000 residents (7th lowest)
> Drug overdose fatalities: 27.4 per 100,000 residents (11th highest)
> Adult smoking rate: 13.3% (4th lowest)
> Adult obesity rate: 25.2% (9th lowest)

48. California
> Deaths before age 75: 268.8 per 100,000 residents
> Vehicle fatalities: 9.2 per 100,000 residents (13th lowest)
> Drug overdose fatalities: 11.2 per 100,000 residents (7th lowest)
> Adult smoking rate: 11.0% (2nd lowest)
> Adult obesity rate: 22.7% (3rd lowest)

47. Hawaii
> Deaths before age 75: 276.3 per 100,000 residents
> Vehicle fatalities: 8.4 per 100,000 residents (9th lowest)
> Drug overdose fatalities: 12.8 per 100,000 residents (12th lowest)
> Adult smoking rate: 13.1% (3rd lowest)
> Adult obesity rate: 22.3% (2nd lowest)

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46. New York
> Deaths before age 75: 278.1 per 100,000 residents
> Vehicle fatalities: 5.2 per 100,000 residents (2nd lowest)
> Drug overdose fatalities: 18.0 per 100,000 residents (22nd lowest)
> Adult smoking rate: 14.2% (9th lowest)
> Adult obesity rate: 25.0% (8th lowest)

45. Massachusetts
> Deaths before age 75: 279.1 per 100,000 residents
> Vehicle fatalities: 5.7 per 100,000 residents (3rd lowest)
> Drug overdose fatalities: 33.0 per 100,000 residents (7th highest)
> Adult smoking rate: 13.6% (5th lowest)
> Adult obesity rate: 24.3% (4th lowest)

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44. Colorado
> Deaths before age 75: 281.7 per 100,000 residents
> Vehicle fatalities: 11.0 per 100,000 residents (20th lowest)
> Drug overdose fatalities: 16.6 per 100,000 residents (18th lowest)
> Adult smoking rate: 15.6% (17th lowest)
> Adult obesity rate: 20.5% (the lowest)

43. New Jersey
> Deaths before age 75: 283.4 per 100,000 residents
> Vehicle fatalities: 6.7 per 100,000 residents (4th lowest)
> Drug overdose fatalities: 23.2 per 100,000 residents (18th highest)
> Adult smoking rate: 14.0% (8th lowest)
> Adult obesity rate: 25.9% (12th lowest)

42. Washington
> Deaths before age 75: 286.7 per 100,000 residents
> Vehicle fatalities: 7.4 per 100,000 residents (6th lowest)
> Drug overdose fatalities: 14.5 per 100,000 residents (15th lowest)
> Adult smoking rate: 13.9% (7th lowest)
> Adult obesity rate: 27.0% (15th lowest)

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41. Vermont
> Deaths before age 75: 291.2 per 100,000 residents
> Vehicle fatalities: 9.9 per 100,000 residents (16th lowest)
> Drug overdose fatalities: 22.2 per 100,000 residents (20th highest)
> Adult smoking rate: 17.0% (24th lowest)
> Adult obesity rate: 24.7% (6th lowest)

40. Utah
> Deaths before age 75: 292.4 per 100,000 residents
> Vehicle fatalities: 9.2 per 100,000 residents (12th lowest)
> Drug overdose fatalities: 22.4 per 100,000 residents (19th highest)
> Adult smoking rate: 8.8% (the lowest)
> Adult obesity rate: 25.3% (10th lowest)

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39. Rhode Island
> Deaths before age 75: 301.7 per 100,000 residents
> Vehicle fatalities: 4.8 per 100,000 residents (the lowest)
> Drug overdose fatalities: 30.8 per 100,000 residents (8th highest)
> Adult smoking rate: 14.4% (11th lowest)
> Adult obesity rate: 27.2% (17th lowest)

38. New Hampshire
> Deaths before age 75: 301.8 per 100,000 residents
> Vehicle fatalities: 10.2 per 100,000 residents (17th lowest)
> Drug overdose fatalities: 39.0 per 100,000 residents (3rd highest)
> Adult smoking rate: 18.0% (20th highest)
> Adult obesity rate: 27.9% (19th lowest)

37. Wisconsin
> Deaths before age 75: 303.1 per 100,000 residents
> Vehicle fatalities: 10.5 per 100,000 residents (18th lowest)
> Drug overdose fatalities: 19.3 per 100,000 residents (25th lowest)
> Adult smoking rate: 17.1% (25th lowest)
> Adult obesity rate: 30.6% (18th highest)

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36. Idaho
> Deaths before age 75: 306.6 per 100,000 residents
> Vehicle fatalities: 15.0 per 100,000 residents (15th highest)
> Drug overdose fatalities: 15.2 per 100,000 residents (16th lowest)
> Adult smoking rate: 14.5% (12th lowest)
> Adult obesity rate: 28.6% (24th lowest)

35. Nebraska
> Deaths before age 75: 309.0 per 100,000 residents
> Vehicle fatalities: 11.4 per 100,000 residents (23rd lowest)
> Drug overdose fatalities: 6.4 per 100,000 residents (the lowest)
> Adult smoking rate: 17.0% (23rd lowest)
> Adult obesity rate: 30.7% (17th highest)

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34. Oregon
> Deaths before age 75: 309.9 per 100,000 residents
> Vehicle fatalities: 12.1 per 100,000 residents (25th lowest)
> Drug overdose fatalities: 11.9 per 100,000 residents (9th lowest)
> Adult smoking rate: 16.2% (19th lowest)
> Adult obesity rate: 27.2% (17th lowest)

33. Iowa
> Deaths before age 75: 313.3 per 100,000 residents
> Vehicle fatalities: 12.9 per 100,000 residents (23rd highest)
> Drug overdose fatalities: 10.6 per 100,000 residents (5th lowest)
> Adult smoking rate: 16.7% (22nd lowest)
> Adult obesity rate: 31.8% (12th highest)

32. Virginia
> Deaths before age 75: 316.7 per 100,000 residents
> Vehicle fatalities: 9.0 per 100,000 residents (11th lowest)
> Drug overdose fatalities: 16.7 per 100,000 residents (19th lowest)
> Adult smoking rate: 15.3% (15th lowest)
> Adult obesity rate: 28.3% (21st lowest)

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31. North Dakota
> Deaths before age 75: 317.5 per 100,000 residents
> Vehicle fatalities: 14.9 per 100,000 residents (16th highest)
> Drug overdose fatalities: 10.6 per 100,000 residents (5th lowest)
> Adult smoking rate: 19.8% (13th highest)
> Adult obesity rate: 31.8% (12th highest)

30. Illinois
> Deaths before age 75: 324.3 per 100,000 residents
> Vehicle fatalities: 8.5 per 100,000 residents (10th lowest)
> Drug overdose fatalities: 18.9 per 100,000 residents (24th lowest)
> Adult smoking rate: 15.8% (18th lowest)
> Adult obesity rate: 28.0% (20th lowest)

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29. Maryland
> Deaths before age 75: 326.4 per 100,000 residents
> Vehicle fatalities: 8.4 per 100,000 residents (8th lowest)
> Drug overdose fatalities: 33.2 per 100,000 residents (6th highest)
> Adult smoking rate: 13.7% (6th lowest)
> Adult obesity rate: 29.2% (25th highest)

28. Maine
> Deaths before age 75: 327.7 per 100,000 residents
> Vehicle fatalities: 12.1 per 100,000 residents (24th lowest)
> Drug overdose fatalities: 28.7 per 100,000 residents (10th highest)
> Adult smoking rate: 19.8% (14th highest)
> Adult obesity rate: 29.0% (25th lowest)

27. Arizona
> Deaths before age 75: 328.1 per 100,000 residents
> Vehicle fatalities: 13.9 per 100,000 residents (20th highest)
> Drug overdose fatalities: 20.3 per 100,000 residents (24th highest)
> Adult smoking rate: 14.7% (13th lowest)
> Adult obesity rate: 26.7% (13th lowest)

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26. South Dakota
> Deaths before age 75: 328.4 per 100,000 residents
> Vehicle fatalities: 13.4 per 100,000 residents (22nd highest)
> Drug overdose fatalities: 8.4 per 100,000 residents (2nd lowest)
> Adult smoking rate: 18.1% (19th highest)
> Adult obesity rate: 30.6% (18th highest)

25. Florida
> Deaths before age 75: 332.3 per 100,000 residents
> Vehicle fatalities: 15.4 per 100,000 residents (13th highest)
> Drug overdose fatalities: 23.7 per 100,000 residents (16th highest)
> Adult smoking rate: 15.5% (16th lowest)
> Adult obesity rate: 25.9% (12th lowest)

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24. Texas
> Deaths before age 75: 341.3 per 100,000 residents
> Vehicle fatalities: 13.6 per 100,000 residents (21st highest)
> Drug overdose fatalities: 10.1 per 100,000 residents (3rd lowest)
> Adult smoking rate: 14.3% (10th lowest)
> Adult obesity rate: 28.4% (22nd lowest)

23. Delaware
> Deaths before age 75: 343.7 per 100,000 residents
> Vehicle fatalities: 12.5 per 100,000 residents (24th highest)
> Drug overdose fatalities: 30.8 per 100,000 residents (8th highest)
> Adult smoking rate: 17.7% (24th highest)
> Adult obesity rate: 30.6% (18th highest)

22. Montana
> Deaths before age 75: 345.4 per 100,000 residents
> Vehicle fatalities: 18.2 per 100,000 residents (8th highest)
> Drug overdose fatalities: 11.7 per 100,000 residents (8th lowest)
> Adult smoking rate: 18.5% (18th highest)
> Adult obesity rate: 25.0% (8th lowest)

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21. Kansas
> Deaths before age 75: 345.6 per 100,000 residents
> Vehicle fatalities: 14.8 per 100,000 residents (17th highest)
> Drug overdose fatalities: 11.1 per 100,000 residents (6th lowest)
> Adult smoking rate: 17.2% (25th highest)
> Adult obesity rate: 32.4% (8th highest)

20. Pennsylvania
> Deaths before age 75: 349.1 per 100,000 residents
> Vehicle fatalities: 9.3 per 100,000 residents (14th lowest)
> Drug overdose fatalities: 37.9 per 100,000 residents (4th highest)
> Adult smoking rate: 18.0% (21st highest)
> Adult obesity rate: 29.6% (22nd highest)

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19. Wyoming
> Deaths before age 75: 351.4 per 100,000 residents
> Vehicle fatalities: 19.1 per 100,000 residents (5th highest)
> Drug overdose fatalities: 17.6 per 100,000 residents (21st lowest)
> Adult smoking rate: 18.9% (17th highest)
> Adult obesity rate: 28.5% (23rd lowest)

18. Alaska
> Deaths before age 75: 356.8 per 100,000 residents
> Vehicle fatalities: 11.3 per 100,000 residents (22nd lowest)
> Drug overdose fatalities: 16.8 per 100,000 residents (20th lowest)
> Adult smoking rate: 19.0% (16th highest)
> Adult obesity rate: 29.4% (24th highest)

17. Nevada
> Deaths before age 75: 363.4 per 100,000 residents
> Vehicle fatalities: 11.2 per 100,000 residents (21st lowest)
> Drug overdose fatalities: 21.7 per 100,000 residents (22nd highest)
> Adult smoking rate: 16.5% (20th lowest)
> Adult obesity rate: 26.8% (14th lowest)

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16. Michigan
> Deaths before age 75: 363.6 per 100,000 residents
> Vehicle fatalities: 10.7 per 100,000 residents (19th lowest)
> Drug overdose fatalities: 24.4 per 100,000 residents (14th highest)
> Adult smoking rate: 20.4% (11th highest)
> Adult obesity rate: 31.3% (16th highest)

15. North Carolina
> Deaths before age 75: 367.5 per 100,000 residents
> Vehicle fatalities: 14.3 per 100,000 residents (19th highest)
> Drug overdose fatalities: 19.7 per 100,000 residents (25th highest)
> Adult smoking rate: 17.9% (23rd highest)
> Adult obesity rate: 29.6% (22nd highest)

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14. Georgia
> Deaths before age 75: 380.2 per 100,000 residents
> Vehicle fatalities: 15.1 per 100,000 residents (14th highest)
> Drug overdose fatalities: 13.3 per 100,000 residents (13th lowest)
> Adult smoking rate: 17.9% (22nd highest)
> Adult obesity rate: 30.2% (21st highest)

13. New Mexico
> Deaths before age 75: 384.5 per 100,000 residents
> Vehicle fatalities: 19.3 per 100,000 residents (4th highest)
> Drug overdose fatalities: 25.2 per 100,000 residents (12th highest)
> Adult smoking rate: 16.6% (21st lowest)
> Adult obesity rate: 24.4% (5th lowest)

12. Missouri
> Deaths before age 75: 390.4 per 100,000 residents
> Vehicle fatalities: 15.5 per 100,000 residents (12th highest)
> Drug overdose fatalities: 23.6 per 100,000 residents (17th highest)
> Adult smoking rate: 22.1% (7th highest)
> Adult obesity rate: 31.8% (12th highest)

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11. Ohio
> Deaths before age 75: 391.1 per 100,000 residents
> Vehicle fatalities: 9.7 per 100,000 residents (15th lowest)
> Drug overdose fatalities: 39.1 per 100,000 residents (2nd highest)
> Adult smoking rate: 22.5% (6th highest)
> Adult obesity rate: 31.6% (15th highest)

10. Indiana
> Deaths before age 75: 391.7 per 100,000 residents
> Vehicle fatalities: 12.4 per 100,000 residents (25th highest)
> Drug overdose fatalities: 24.0 per 100,000 residents (15th highest)
> Adult smoking rate: 21.1% (10th highest)
> Adult obesity rate: 32.0% (10th highest)

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9. South Carolina
> Deaths before age 75: 409.4 per 100,000 residents
> Vehicle fatalities: 20.5 per 100,000 residents (3rd highest)
> Drug overdose fatalities: 18.1 per 100,000 residents (23rd lowest)
> Adult smoking rate: 20.0% (12th highest)
> Adult obesity rate: 32.0% (10th highest)

8. Tennessee
> Deaths before age 75: 441.4 per 100,000 residents
> Vehicle fatalities: 15.7 per 100,000 residents (11th highest)
> Drug overdose fatalities: 24.5 per 100,000 residents (13th highest)
> Adult smoking rate: 22.1% (8th highest)
> Adult obesity rate: 32.4% (8th highest)

7. Louisiana
> Deaths before age 75: 451.0 per 100,000 residents
> Vehicle fatalities: 16.2 per 100,000 residents (10th highest)
> Drug overdose fatalities: 21.8 per 100,000 residents (21st highest)
> Adult smoking rate: 22.8% (4th highest)
> Adult obesity rate: 34.7% (3rd highest)

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6. Arkansas
> Deaths before age 75: 458.2 per 100,000 residents
> Vehicle fatalities: 18.2 per 100,000 residents (7th highest)
> Drug overdose fatalities: 14.0 per 100,000 residents (14th lowest)
> Adult smoking rate: 23.6% (3rd highest)
> Adult obesity rate: 34.6% (5th highest)

5. Oklahoma
> Deaths before age 75: 459.4 per 100,000 residents
> Vehicle fatalities: 17.4 per 100,000 residents (9th highest)
> Drug overdose fatalities: 21.5 per 100,000 residents (23rd highest)
> Adult smoking rate: 19.6% (15th highest)
> Adult obesity rate: 33.2% (7th highest)

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4. Kentucky
> Deaths before age 75: 466.5 per 100,000 residents
> Vehicle fatalities: 18.8 per 100,000 residents (6th highest)
> Drug overdose fatalities: 33.5 per 100,000 residents (5th highest)
> Adult smoking rate: 24.5% (2nd highest)
> Adult obesity rate: 33.7% (6th highest)

3. Alabama
> Deaths before age 75: 468.7 per 100,000 residents
> Vehicle fatalities: 21.3 per 100,000 residents (2nd highest)
> Drug overdose fatalities: 16.2 per 100,000 residents (17th lowest)
> Adult smoking rate: 21.5% (9th highest)
> Adult obesity rate: 34.7% (3rd highest)

2. West Virginia
> Deaths before age 75: 480.3 per 100,000 residents
> Vehicle fatalities: 14.7 per 100,000 residents (18th highest)
> Drug overdose fatalities: 52.0 per 100,000 residents (the highest)
> Adult smoking rate: 24.8% (the highest)
> Adult obesity rate: 35.5% (the highest)

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1. Mississippi
> Deaths before age 75: 497.4 per 100,000 residents
> Vehicle fatalities: 23.1 per 100,000 residents (the highest)
> Drug overdose fatalities: 12.1 per 100,000 residents (10th lowest)
> Adult smoking rate: 22.7% (5th highest)
> Adult obesity rate: 35.3% (2nd highest)

Detailed Findings & Methodology

Graham told 24/7 Wall St. that the rise of premature deaths in the United States, specifically among whites, came as a result of a “perfect storm” decades in the making.

“Drops in optimism among less than college-educated whites started in the late ‘70s, coincided with the decline of the blue-collar working class,” Graham said. By the 1990s, Americans, particularly current and former working class white Americans, were being over-prescribed opioids. As the medical community began to cut back on opioid prescriptions, hundreds of thousands of Americans who became opioid dependant fell prey to the illegal drug trade.

At the same time, Graham added, the levels of addiction, overdose, and other deaths of despair have increased as economic conditions worsened for the same group of Americans. “Technology-driven industries go up, the heartland gets more and more desperate, more and more addicted, and it [became] a vicious circle.”

While deaths of despair, including deaths caused by the opioid epidemic, have disproportionately afflicted white Americans, black and Hispanic Americans continue to face worse social and economic conditions and have higher premature mortality rates.

“But the blacks and Hispanics are narrowing the gap with whites,” Graham noted. “They are not part of the deaths of despair epidemic. [Black and Hispanic Americans] are much less likely to report depression, and they’re much less likely to commit suicide. They’re also much less likely to be prescribed opioids. So you get a rise in our mortality rate driven by premature deaths among less than college-educated, middle aged whites.”

Many of the states with the highest premature mortality rates do not have the highest drug overdose rates or suicide rates. However, many struggle with other issues afflicting lower-income, lower-educated populations, namely unhealthy behaviors. All 10 of the states with the highest premature mortality rates have among the 15 highest smoking and obesity rates among adults.

As a consequence of these and other unhealthy behaviors, such as sedentary lifestyles, these states have the highest rate of cancer and heart disease. These are diseases that do not tend to affect Americans before the age of 45, unlike overdoses. Unintentional injury is the leading cause of death for all Americans aged 1 through 44, killing about 62,000 people in that age group. However, cancer alone resulted in the death of more than 500,000 55-65 year olds.

For this reason, the correlation with diseases like cancer and heart disease, often the result of long-term unhealthy behavior, is very high with the premature mortality rate across states.

24/7 Wall St. ranked all 50 states based on their premature mortality rates, with data from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program. Premature mortality includes all deaths of a population before the age of 75, and this data covers 2014-2016. In our analysis, we considered other data from County Health Rankings, including adult obesity rates, adult smoking rates, and the share of adults reporting good or excellent health. From the U.S. Centers for Disease Control and Prevention, we reviewed the suicide rate per 100,000 residents. From the U.S. Census Bureau, we reviewed median household income, poverty, and educational attainment rates. Age-specific death rates came from the CDC WONDER database. Drug overdose fatalities per capita also came from the CDC and are for 2016. Vehicle fatalities per 100,000 residents came from the Fatality Analysis Reporting System provided by the National Highway Traffic Safety Administration and are for 2016.

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