Special Report
States Where the Premature Death Is the Highest: See Where Your State Ranks
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Published: November 27, 2023 10:00 am
Researchers at institutions including the Commonwealth Fund have found that a surge in the premature death rate, defined as deaths before the age of 75, was largely spurred by COVID-19 – either directly or because the pandemic contributed to elevated narcotics abuse and obstructed care for treatable diseases such as diabetes and cancer.
To assemble a ranked list of the states with the highest premature death rates, 24/7 Tempo reviewed data from County Health Rankings & Roadmaps , a joint program of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, covering the years 2018-2020. Though COVID didn’t affect the premature death rate in 2018 and 2019, it had a major impact in 2020.
Instances of premature mortality vary widely from state to state, from 280 per 100,000 residents in Minnesota to 543 per 100,000 in Mississippi. Nine of the 10 states with the highest premature death rates are in the South, and all nine also had the lowest life expectancy at birth. Seven of these states had the highest obesity and smoking rates, too. (These are the U.S. cities with the most smokers .)
The highest drug overdose rates occurred in the Midwestern states of Ohio, Illinois, and Michigan. West Virginia and Mississippi have the highest smoking and obesity rates. California, the most populous state, may have the second-highest life expectancy (81.01 years), but it also has the nation’s highest number of injury deaths and drug overdoses. (Here’s a ranking of the states where people live the longest .)
States with lower premature death rates are largely found on either coast – California, Washington, Hawaii, Massachusetts, Connecticut, and New Hampshire. These states are also among the top 10 in highest life expectancy.
Methodology
To rank all 50 states based on their premature mortality rates, 24/7 Tempo reviewed data for the years 2018 to 2020 from County Health Rankings & Roadmaps, a joint program of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Premature mortality includes all deaths in a population before the age of 75. Adult obesity and adult smoking rates, two of the top risk factors of premature death, are from 2020; drug overdose deaths and data on life expectancy at birth – the average number of years a person can expect to live – are for 2018-2020. All four metrics are also from the 2023 CHR. Injury death rates, from the 2023 CHR, are for 2016-2020. Injury deaths include both accidental and intentional fatalities.
Here is a ranking of the states with the highest (and lowest) premature death rates.
50. Minnesota
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Deaths before age 75 (2018-2020) : 280 per 100,000 residents
Life expectancy at birth: 80.4 years – 3rd highest
Drug overdose deaths ( 2018-2020): 2,478 per 100,000 residents – 23rd lowest
Deaths due to injury (2016-2020): 19,454 per 100,000 residents – 25th lowest
Adult smoking rate (2020): 14.30% – 19th lowest
Adult obesity rate (2020): 30.60% – 16th lowest
49. California
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Deaths before age 75 (2018-2020) : 288 per 100,000 residents
Life expectancy at birth: 81.01 years – 2nd highest
Drug overdose deaths ( 2018-2020): 20,454 per 100,000 residents – the highest
Deaths due to injury (2016-2020): 108,182 per 100,000 residents – the highest
Adult smoking rate (2020): 9.00% – 2nd lowest
Adult obesity rate (2020): 30.20% – 14th lowest
48. Massachusetts
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Deaths before age 75 (2018-2020) : 288 per 100,000 residents
Life expectancy at birth: 80.19 years – 6th highest
Drug overdose deaths ( 2018-2020): 6,753 per 100,000 residents – 13th highest
Deaths due to injury (2016-2020): 24,245 per 100,000 residents – 20th highest
Adult smoking rate (2020): 11.40% – 5th lowest
Adult obesity rate (2020): 24.50% – 2nd lowest
47. Hawaii
Deaths before age 75 (2018-2020) : 289 per 100,000 residents
Life expectancy at birth: 82.26 years – the highest
Drug overdose deaths ( 2018-2020): 729 per 100,000 residents – 8th lowest
Deaths due to injury (2016-2020): 4,410 per 100,000 residents – 8th lowest
Adult smoking rate (2020): 12.20% – 7th lowest
Adult obesity rate (2020): 25.00% – 3rd lowest
46. Utah
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Deaths before age 75 (2018-2020) : 291 per 100,000 residents
Life expectancy at birth: 79.72 years – 9th highest
Drug overdose deaths ( 2018-2020): 1,817 per 100,000 residents – 18th lowest
Deaths due to injury (2016-2020): 10,605 per 100,000 residents – 14th lowest
Adult smoking rate (2020): 8.30% – the lowest
Adult obesity rate (2020): 29.30% – 12th lowest
45. Washington
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Deaths before age 75 (2018-2020) : 296 per 100,000 residents
Life expectancy at birth: 80.21 years – 5th highest
Drug overdose deaths ( 2018-2020): 4,156 per 100,000 residents – 21st highest
Deaths due to injury (2016-2020): 25,947 per 100,000 residents – 18th highest
Adult smoking rate (2020): 11.60% – 6th lowest
Adult obesity rate (2020): 28.00% – 7th lowest
44. Connecticut
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Deaths before age 75 (2018-2020) : 298 per 100,000 residents
Life expectancy at birth: 80.11 years – 7th highest
Drug overdose deaths ( 2018-2020): 3,654 per 100,000 residents – 24th highest
Deaths due to injury (2016-2020): 13,494 per 100,000 residents – 21st lowest
Adult smoking rate (2020): 12.60% – 10th lowest
Adult obesity rate (2020): 29.50% – 13th lowest
43. Colorado
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Deaths before age 75 (2018-2020) : 298 per 100,000 residents
Life expectancy at birth: 79.98 years – 8th highest
Drug overdose deaths ( 2018-2020): 3,566 per 100,000 residents – 25th highest
Deaths due to injury (2016-2020): 23,685 per 100,000 residents – 22nd highest
Adult smoking rate (2020): 12.60% – 9th lowest
Adult obesity rate (2020): 24.20% – the lowest
42. New Hampshire
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Deaths before age 75 (2018-2020) : 307 per 100,000 residents
Life expectancy at birth: 79.59 years – 13th highest
Drug overdose deaths ( 2018-2020): 1,252 per 100,000 residents – 14th lowest
Deaths due to injury (2016-2020): 6,006 per 100,000 residents – 11th lowest
Adult smoking rate (2020): 14.70% – 22nd lowest
Adult obesity rate (2020): 30.50% – 15th lowest
41. New York
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Deaths before age 75 (2018-2020) : 307 per 100,000 residents
Life expectancy at birth: 80.26 years – 4th highest
Drug overdose deaths ( 2018-2020): 12,279 per 100,000 residents – 5th highest
Deaths due to injury (2016-2020): 52,179 per 100,000 residents – 6th highest
Adult smoking rate (2020): 12.30% – 8th lowest
Adult obesity rate (2020): 26.50% – 5th lowest
40. Vermont
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Deaths before age 75 (2018-2020) : 309 per 100,000 residents
Life expectancy at birth: 79.67 years –12th highest
Drug overdose deaths ( 2018-2020): 476 per 100,000 residents – 6th lowest
Deaths due to injury (2016-2020): 2,827 per 100,000 residents – 3rd lowest
Adult smoking rate (2020): 14.40% – 20th lowest
Adult obesity rate (2020): 26.30% – 4th lowest
39. Idaho
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Deaths before age 75 (2018-2020) : 311 per 100,000 residents
Life expectancy at birth: 79.19 years – 16th highest
Drug overdose deaths ( 2018-2020): 802 per 100,000 residents – 9th lowest
Deaths due to injury (2016-2020): 6,820 per 100,000 residents – 13th lowest
Adult smoking rate (2020): 14.20% – 18th lowest
Adult obesity rate (2020): 31.30% – 20th lowest
38. Oregon
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Deaths before age 75 (2018-2020) : 311 per 100,000 residents
Life expectancy at birth: 79.7 years – 10th highest
Drug overdose deaths ( 2018-2020): 1,965 per 100,000 residents – 20th lowest
Deaths due to injury (2016-2020): 16,114 per 100,000 residents – 23rd lowest
Adult smoking rate (2020): 13.60% – 13th lowest
Adult obesity rate (2020): 28.30% – 10th lowest
37. Rhode Island
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Deaths before age 75 (2018-2020) : 314 per 100,000 residents
Life expectancy at birth: 79.37 years – 15th highest
Drug overdose deaths ( 2018-2020): 1,021 per 100,000 residents – 10th lowest
Deaths due to injury (2016-2020): 4,334 per 100,000 residents – 7th lowest
Adult smoking rate (2020): 14.10% – 16th lowest
Adult obesity rate (2020): 30.60% – 18th lowest
36. New Jersey
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Deaths before age 75 (2018-2020) : 319 per 100,000 residents
Life expectancy at birth: 79.49 years – 14th highest
Drug overdose deaths ( 2018-2020): 8,545 per 100,000 residents – 8th highest
Deaths due to injury (2016-2020): 28,188 per 100,000 residents – 16th highest
Adult smoking rate (2020): 11.10% – 3rd lowest
Adult obesity rate (2020): 27.70% – 6th lowest
35. Wisconsin
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Deaths before age 75 (2018-2020) : 324 per 100,000 residents
Life expectancy at birth: 78.87 years – 20th highest
Drug overdose deaths ( 2018-2020): 3,811 per 100,000 residents – 23rd highest
Deaths due to injury (2016-2020): 25,889 per 100,000 residents – 19th highest
Adult smoking rate (2020): 16.10% – 25th lowest
Adult obesity rate (2020): 32.70% – 23rd highest
34. Nebraska
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Deaths before age 75 (2018-2020) : 328 per 100,000 residents
Life expectancy at birth: 79.02 years – 19th highest
Drug overdose deaths ( 2018-2020): 513 per 100,000 residents – 7th lowest
Deaths due to injury (2016-2020): 5,920 per 100,000 residents – 10th lowest
Adult smoking rate (2020): 14.50% – 21st lowest
Adult obesity rate (2020): 34.00% – 19th highest
33. Virginia
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Deaths before age 75 (2018-2020) : 335 per 100,000 residents
Life expectancy at birth: 79.07 years – 17th highest
Drug overdose deaths ( 2018-2020): 5,235 per 100,000 residents – 16th highest
Deaths due to injury (2016-2020): 28,895 per 100,000 residents – 14th highest
Adult smoking rate (2020): 13.90% – 15th lowest
Adult obesity rate (2020): 32.40% – 25th highest
32. Iowa
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Deaths before age 75 (2018-2020) : 340 per 100,000 residents
Life expectancy at birth: 78.74 years – 22nd highest
Drug overdose deaths ( 2018-2020): 1,071 per 100,000 residents – 11th lowest
Deaths due to injury (2016-2020): 10,982 per 100,000 residents – 15th lowest
Adult smoking rate (2020): 16.80% – 23rd highest
Adult obesity rate (2020): 37.20% – 5th highest
31. North Dakota
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Deaths before age 75 (2018-2020) : 343 per 100,000 residents
Life expectancy at birth: 78.77 years – 21st highest
Drug overdose deaths ( 2018-2020): 266 per 100,000 residents – 3rd lowest
Deaths due to injury (2016-2020): 2,749 per 100,000 residents – the lowest
Adult smoking rate (2020): 17.90% – 18th highest
Adult obesity rate (2020): 33.60% – 20th highest
30. Maine
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Deaths before age 75 (2018-2020) : 344 per 100,000 residents
Life expectancy at birth: 78.56 years – 25th lowest
Drug overdose deaths ( 2018-2020): 1,212 per 100,000 residents – 12th lowest
Deaths due to injury (2016-2020): 6,566 per 100,000 residents – 12th lowest
Adult smoking rate (2020): 18.00% – 16th highest
Adult obesity rate (2020): 31.30% – 21st lowest
29. Florida
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Deaths before age 75 (2018-2020) : 351 per 100,000 residents
Life expectancy at birth: 79.69 years – 11th highest
Drug overdose deaths ( 2018-2020): 17,197 per 100,000 residents – 2nd highest
Deaths due to injury (2016-2020): 92,013 per 100,000 residents – 2nd highest
Adult smoking rate (2020): 15.50% – 23rd lowest
Adult obesity rate (2020): 28.30% – 9th lowest
28. Illinois
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Deaths before age 75 (2018-2020) : 352 per 100,000 residents
Life expectancy at birth: 78.62 years – 23rd highest
Drug overdose deaths ( 2018-2020): 9,061 per 100,000 residents – 7th highest
Deaths due to injury (2016-2020): 44,389 per 100,000 residents – 7th highest
Adult smoking rate (2020): 12.80% – 11th lowest
Adult obesity rate (2020): 32.50% – 24th highest
27. Montana
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Deaths before age 75 (2018-2020) : 353 per 100,000 residents
Life expectancy at birth: 78.37 years – 23rd lowest
Drug overdose deaths ( 2018-2020): 430 per 100,000 residents – 5th lowest
Deaths due to injury (2016-2020): 5,001 per 100,000 residents – 9th lowest
Adult smoking rate (2020): 17.50% – 19th highest
Adult obesity rate (2020): 28.90% – 11th lowest
26. South Dakota
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Deaths before age 75 (2018-2020) : 353 per 100,000 residents
Life expectancy at birth: 78.19 years – 22nd lowest
Drug overdose deaths ( 2018-2020): 226 per 100,000 residents – the lowest
Deaths due to injury (2016-2020): 3,709 per 100,000 residents – 5th lowest
Adult smoking rate (2020): 19.00% – 13th highest
Adult obesity rate (2020): 33.40% – 22nd highest
25. Maryland
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Deaths before age 75 (2018-2020) : 358 per 100,000 residents
Life expectancy at birth: 78.58 years – 25th highest
Drug overdose deaths ( 2018-2020): 7,464 per 100,000 residents – 11th highest
Deaths due to injury (2016-2020): 26,687 per 100,000 residents – 17th highest
Adult smoking rate (2020): 11.10% – 4th lowest
Adult obesity rate (2020): 30.90% – 19th lowest
24. Arizona
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Deaths before age 75 (2018-2020) : 360 per 100,000 residents
Life expectancy at birth: 79.06 years – 18th highest
Drug overdose deaths ( 2018-2020): 6,127 per 100,000 residents – 14th highest
Deaths due to injury (2016-2020): 32,367 per 100,000 residents – 12th highest
Adult smoking rate (2020): 13.70% – 14th lowest
Adult obesity rate (2020): 31.50% – 22nd lowest
23. Texas
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Deaths before age 75 (2018-2020) : 362 per 100,000 residents
Life expectancy at birth: 78.39 years – 24th lowest
Drug overdose deaths ( 2018-2020): 10,313 per 100,000 residents – 6th highest
Deaths due to injury (2016-2020): 85,669 per 100,000 residents – 3rd highest
Adult smoking rate (2020): 13.30% – 12th lowest
Adult obesity rate (2020): 35.80% – 14th highest
22. Alaska
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Deaths before age 75 (2018-2020) : 364 per 100,000 residents
Life expectancy at birth: 78.62 years – 23rd highest
Drug overdose deaths ( 2018-2020): 402 per 100,000 residents – 4th lowest
Deaths due to injury (2016-2020): 3,673 per 100,000 residents – 4th lowest
Adult smoking rate (2020): 18.00% – 17th highest
Adult obesity rate (2020): 31.80% – 25th lowest
21. Pennsylvania
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Deaths before age 75 (2018-2020) : 366 per 100,000 residents
Life expectancy at birth: 78.02 years – 19th lowest
Drug overdose deaths ( 2018-2020): 13,960 per 100,000 residents – 3rd highest
Deaths due to injury (2016-2020): 59,315 per 100,000 residents – 4th highest
Adult smoking rate (2020): 16.70% – 24th highest
Adult obesity rate (2020): 31.60% – 23rd lowest
20. Wyoming
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Deaths before age 75 (2018-2020) : 368 per 100,000 residents
Life expectancy at birth: 78.08 years – 20th lowest
Drug overdose deaths ( 2018-2020): 244 per 100,000 residents – 2nd lowest
Deaths due to injury (2016-2020): 2,771 per 100,000 residents – 2nd lowest
Adult smoking rate (2020): 19.40% – 10th highest
Adult obesity rate (2020): 30.60% – 17th lowest
19. Delaware
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Deaths before age 75 (2018-2020) : 371 per 100,000 residents
Life expectancy at birth: 78.01 years –18th lowest
Drug overdose deaths ( 2018-2020): 1,280 per 100,000 residents – 15th lowest
Deaths due to injury (2016-2020): 4,211 per 100,000 residents – 6th lowest
Adult smoking rate (2020): 15.80% – 24th lowest
Adult obesity rate (2020): 36.20% – 11th highest
18. Kansas
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Deaths before age 75 (2018-2020) : 373 per 100,000 residents
Life expectancy at birth: 77.81 years – 17th lowest
Drug overdose deaths ( 2018-2020): 1,238 per 100,000 residents – 13th lowest
Deaths due to injury (2016-2020): 11,410 per 100,000 residents – 16th lowest
Adult smoking rate (2020): 17.20% – 20th highest
Adult obesity rate (2020): 35.80% – 15th highest
17. Nevada
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Deaths before age 75 (2018-2020) : 379 per 100,000 residents
Life expectancy at birth: 78.11 years – 21st lowest
Drug overdose deaths ( 2018-2020): 2,167 per 100,000 residents – 22nd lowest
Deaths due to injury (2016-2020): 12,159 per 100,000 residents – 19th lowest
Adult smoking rate (2020): 14.10% – 17th lowest
Adult obesity rate (2020): 28.10% – 8th lowest
16. North Carolina
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Deaths before age 75 (2018-2020) : 384 per 100,000 residents
Life expectancy at birth: 77.68 years –16th lowest
Drug overdose deaths ( 2018-2020): 7,671 per 100,000 residents – 10th highest
Deaths due to injury (2016-2020): 42,426 per 100,000 residents – 8th highest
Adult smoking rate (2020): 17.00% – 21st highest
Adult obesity rate (2020): 33.60% – 21st highest
15. Michigan
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Deaths before age 75 (2018-2020) : 385 per 100,000 residents
Life expectancy at birth: 77.48 years – 15th lowest
Drug overdose deaths ( 2018-2020): 7,735 per 100,000 residents – 9th highest
Deaths due to injury (2016-2020): 40,427 per 100,000 residents – 9th highest
Adult smoking rate (2020): 19.30% – 11th highest
Adult obesity rate (2020): 35.30% – 16th highest
14. Georgia
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Deaths before age 75 (2018-2020) : 400 per 100,000 residents
Life expectancy at birth: 77.31 years – 14th lowest
Drug overdose deaths ( 2018-2020): 4,728 per 100,000 residents – 19th highest
Deaths due to injury (2016-2020): 36,347 per 100,000 residents – 10th highest
Adult smoking rate (2020): 16.30% – 25th highest
Adult obesity rate (2020): 34.30% – 17th highest
13. Indiana
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Deaths before age 75 (2018-2020) : 420 per 100,000 residents
Life expectancy at birth: 76.51 years – 10th lowest
Drug overdose deaths ( 2018-2020): 5,649 per 100,000 residents – 15th highest
Deaths due to injury (2016-2020): 28,315 per 100,000 residents – 15th highest
Adult smoking rate (2020): 20.20% – 5th highest
Adult obesity rate (2020): 37.20% – 7th highest
12. Ohio
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Deaths before age 75 (2018-2020) : 420 per 100,000 residents
Life expectancy at birth: 76.52 years – 11th lowest
Drug overdose deaths ( 2018-2020): 13,435 per 100,000 residents – 4th highest
Deaths due to injury (2016-2020): 55,929 per 100,000 residents – 5th highest
Adult smoking rate (2020): 20.20% – 6th highest
Adult obesity rate (2020): 35.80% – 13th highest
11. Missouri
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Deaths before age 75 (2018-2020) : 426 per 100,000 residents
Life expectancy at birth: 76.64 years – 12th lowest
Drug overdose deaths ( 2018-2020): 5,068 per 100,000 residents – 17th highest
Deaths due to injury (2016-2020): 29,326 per 100,000 residents – 13th highest
Adult smoking rate (2020): 18.60% – 15th highest
Adult obesity rate (2020): 34.20% – 18th highest
10. South Carolina
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Deaths before age 75 (2018-2020) : 434 per 100,000 residents
Life expectancy at birth: 76.44 years – 10th lowest
Drug overdose deaths ( 2018-2020): 3,991 per 100,000 residents – 22nd highest
Deaths due to injury (2016-2020): 23,960 per 100,000 residents – 21st highest
Adult smoking rate (2020): 19.10% – 12th highest
Adult obesity rate (2020): 36.70% – 10th highest
9. New Mexico
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Deaths before age 75 (2018-2020) : 437 per 100,000 residents
Life expectancy at birth: 76.88 years – 13th lowest
Drug overdose deaths ( 2018-2020): 1,920 per 100,000 residents – 19th lowest
Deaths due to injury (2016-2020): 11,815 per 100,000 residents – 17th lowest
Adult smoking rate (2020): 16.90% – 22nd highest
Adult obesity rate (2020): 31.70% – 24th lowest
8. Oklahoma
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Deaths before age 75 (2018-2020) : 477 per 100,000 residents
Life expectancy at birth: 75.54 years – 8th lowest
Drug overdose deaths ( 2018-2020): 2,123 per 100,000 residents – 21st lowest
Deaths due to injury (2016-2020): 18,846 per 100,000 residents – 24th lowest
Adult smoking rate (2020): 19.60% – 8th highest
Adult obesity rate (2020): 37.10% – 8th highest
7. Tennessee
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Deaths before age 75 (2018-2020) : 478 per 100,000 residents
Life expectancy at birth: 75.33 years – 6th lowest
Drug overdose deaths ( 2018-2020): 6,946 per 100,000 residents – 12th highest
Deaths due to injury (2016-2020): 33,732 per 100,000 residents – 11th highest
Adult smoking rate (2020): 19.70% – 7th highest
Adult obesity rate (2020): 35.80% – 12th highest
6. Arkansas
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Deaths before age 75 (2018-2020) : 478 per 100,000 residents
Life expectancy at birth: 75.49 years – 7th lowest
Drug overdose deaths ( 2018-2020): 1,378 per 100,000 residents – 17th lowest
Deaths due to injury (2016-2020): 12,833 per 100,000 residents – 20th lowest
Adult smoking rate (2020): 21.60% – 3rd highest
Adult obesity rate (2020): 37.20% – 6th highest
5. Louisiana
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Deaths before age 75 (2018-2020) : 485 per 100,000 residents
Life expectancy at birth: 75.22 years – 5th lowest
Drug overdose deaths ( 2018-2020): 4,303 per 100,000 residents – 20th highest
Deaths due to injury (2016-2020): 22,341 per 100,000 residents – 24th highest
Adult smoking rate (2020): 18.90% – 14th highest
Adult obesity rate (2020): 38.30% – 4th highest
4. Kentucky
Deaths before age 75 (2018-2020) : 491 per 100,000 residents
Life expectancy at birth: 75.08 years – 4th lowest
Drug overdose deaths ( 2018-2020): 4,778 per 100,000 residents – 18th highest
Deaths due to injury (2016-2020): 22,424 per 100,000 residents – 23rd highest
Adult smoking rate (2020): 22.20% – 2nd highest
Adult obesity rate (2020): 37.00% – 9th highest
3. Alabama
Deaths before age 75 (2018-2020) : 500 per 100,000 residents
Life expectancy at birth: 74.84 years – 3rd lowest
Drug overdose deaths ( 2018-2020): 2,572 per 100,000 residents – 24th lowest
Deaths due to injury (2016-2020): 21,249 per 100,000 residents – 25th highest
Adult smoking rate (2020): 19.50% – 9th highest
Adult obesity rate (2020): 39.30% – 3rd highest
2. West Virginia
Deaths before age 75 (2018-2020) : 528 per 100,000 residents
Life expectancy at birth: 74.26 years – 2nd lowest
Drug overdose deaths ( 2018-2020): 3,056 per 100,000 residents – 25th lowest
Deaths due to injury (2016-2020): 12,039 per 100,000 residents – 18th lowest
Adult smoking rate (2020): 24.00% – the highest
Adult obesity rate (2020): 39.60% – 2nd highest
1. Mississippi
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Deaths before age 75 (2018-2020) : 543 per 100,000 residents
Life expectancy at birth: 73.89 years – the lowest
Drug overdose deaths ( 2018-2020): 1,290 per 100,000 residents – 16th lowest
Deaths due to injury (2016-2020): 13,808 per 100,000 residents – 22nd lowest
Adult smoking rate (2020): 20.70% – 4th highest
Adult obesity rate (2020): 39.90% – the highest
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