How health issues and life expectancy differ from state to state

Health problems aren’t the same everywhere.

Authors of “The State of US Health, 1990-2016 Burden of Diseases, Injuries, and Risk Factors Among US States,” published recently in the Journal of the American Medical Association, undertook a systematic review of studies pertaining to the burden of disease in the United States to identify health risks and trends.  Their research shows the major differences in health between different states and regions of the U.S.

In Hawaii, for example, the life expectancy is 81.3 years, nearly seven years longer than that of Mississippi, where the average person can expect to live 74.7 years. And people are healthiest in wealthier states: Connecticut, California, New York, Massachusetts, New Jersey, Colorado, Minnesota and Washington.

Related: Top 10 states with highest percentage of obesity

“Routinely monitoring the trend of burden of disease at the state level is essential given the vital role of states in many aspects of health and social policy—from the Medicaid program to regulation of private insurers—and considering that individual states also experience different economic circumstances,” the authors write.

In general, health is worse and life expectancy lower in America’s poorest states in Appalachia and the south. West Virginia, Alabama, Kentucky, Arkansas and Oklahoma all have life expectancies below 76.

There are some positive results across the board, including a mortality rate that has declined significantly since 1990, from 745 deaths per 100,000 people to 578.

The two top causes of reduced life expectancy in 2016 were the same as in 1990: heart disease and lung cancer. However, the third place spot in 1990 went to low back pain, which in 2016 had been replaced by chronic obstructive pulmonary disease. Diabetes came in fourth place and low back pain had moved down to fifth place.

Heart disease was the leading cause of decreased life expectancy in every state and lung cancer was the second greatest cause in all but a few states. In New Mexico, for instance, which has long been notorious for drunk driving, road injuries came in second place. In contrast, road injuries were only the tenth leading cause of reduced life expectancy in New York and Massachusetts.

The study assessed a number of different risk factors associated with premature death and found that tobacco use remains the biggest problem. Right behind it, however, is high body mass index, followed in third place by “dietary risks.” In fourth and fifth places were drug and alcohol use and high fasting plasma glucose, respectively.

While tobacco use is the greatest challenge in 32 states, it is only the sixth greatest in Utah and the fourth greatest in California, New Mexico and the District of Columbia. Drug and alcohol use, obesity and dietary risks were all bigger issues in those states.

While smoking has steadily declined in recent years, obesity is on the rise and the country is struggling to deal with an opioid epidemic.

“Although physical activity increased during the study period, the levels of increase were not enough to control weight gain,” the authors wrote. “Physical inactivity is a risk factor for many diseases, but increasing activity is not enough on its own to reduce weight or prevent weight gain.”

The study acknowledged that there are a variety of challenges to improving health, particularly considering the association between health risks, such as poor diet and tobacco use, and poverty.

“To increase the likelihood of prevention to succeed, it has to be a priority for all stakeholders—physicians, nurses, hospital systems, policy makers, health insurance companies, patients and their families, and advocacy groups,” the authors wrote.