Study: America’s deadliest states + ways to improve life expectancy

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Susan Meyer

Senior Editorial Manager

  • Licensed Insurance Agent — Property and Casualty

Susan is a licensed insurance agent and has worked as a writer and editor for over 10 years across a number of industries. She has worked at The Zebr…

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Ross Martin

Insurance Writer

  • 4+ years in the Insurance Industry

Ross joined The Zebra as a writer and researcher in 2019. He specializes in writing insurance content to help shoppers make informed decisions.

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Summary of findings

Over the past two decades, Americans’ general health has improved. Life expectancy has increased by 3.06% from 2000 to 2020.[1] Some areas of the country have experienced increases in life expectancy, while others have seen a decrease.

Several of the states with the lowest life expectancy also have the highest risk of death. Therefore, we wanted to find out which states have the highest risk of death and what the main causes are.

Key insights and findings:

  • Nine of the 10 deadliest states are in the South.
  • In 2019, Mississippi had the highest sum mortality, homicide and poverty rates in the U.S.
  • Eight of the 10 deadliest states are also in the top 10 for the highest poverty rate in the nation.
  • Seven states with the highest homicide rate also rank in the top 10 for highest poverty rate.

Whether you’re a current resident of one of these states or are looking to move states, you can use this data and information to assess which state is best for your overall health. You can also discover ways to improve life expectancy below.

Deadliest states in America

To determine the deadliest states, we calculated the sum mortality rate. Sum mortality rate is the sum of mortalities from the nation’s five leading causes of death in 2019 (heart disease, cancer, accidents, lower respiratory disease and strokes). The sum mortality rate for the five most common diseases is per 100,000 people. We also examined 2019 homicide and poverty rates, which are strong indicators for each state’s life expectancy.

The CDC’s 2019 data is the latest national and state data available. This collected and calculated data allowed us to best assess the general health and risk of death for each state, although it does not include deaths related to the COVID-19 pandemic.



Below are the five most deadly states:

1. Mississippi

Mississippi leads the country in several of the categories we used to measure deadliness. The Magnolia State has the highest sum mortality rate at 586.7 deaths per 100,000 Mississippians.

Additionally, Mississippi is the poorest state in the U.S. with nearly one out of every five residents living in poverty. Mississippi also has the nation’s highest homicide mortality rate at 15.4 fatal homicides per 100,000 residents. This homicide rate is nearly three times the national rate (5.9).



2. West Virginia

West Virginia falls right behind Mississippi with the second-highest sum mortality rate at 575.7. It’s worth noting that West Virginia has the lowest life expectancy rate of any state in the U.S. at 74.4 years.

The Mountain State also struggles with poverty. It has the fifth-highest poverty rate at 16%. One reason for West Virginia’s high poverty rate is its ailing economy, which is due to the dwindling coal production and isolated towns.[2] 



3. Oklahoma

Oklahoma’s nicknamed the Sooner State due to its residents’ history of having a can-do spirit. Unfortunately, the state comes in third on our list of deadliest states.

Oklahoma ranks third in sum mortality rate with 572 deaths per 100,000 residents. The vast majority of these deaths stem from heart disease. In fact, in 2019, Oklahoma’s mortality rate from heart disease was the highest in the nation.[3] One explanation for such a high heart disease rate is that Oklahoma ranks 10th in adult obesity prevalence.[4] To boot, Oklahoma has the seventh-highest poverty rate in the U.S. at 15.2%.



4. Alabama

Despite not placing first in any of the nation’s five leading causes of death, Alabama lands consistently in the top 10 for leading causes of death, smoking and poverty rate.

Alabama is second in the nation in stroke mortality rate, third in obesity and homicide mortality rate and sixth-highest in poverty rate.[5] Due to these factors, Alabama sits fourth on our list of deadliest states.



5. Kentucky

Kentucky comes in fifth in our states with the highest risk of death. Kentucky ties Oklahoma at 62.4 for the highest chronic lower respiratory disease mortality rate.[6] One reason why so many Kentuckians are dying from lung disease is that the state has the second-highest smoking rate in the U.S. at 24.6%. The Bluegrass State also has the third-highest poverty rate at 16.3%.


States with the worst chronic lower respiratory mortality and smoking rates

Chronic lower respiratory (lung) diseases are the fourth leading cause of death behind heart disease, cancer and accidents. Lung diseases made up 5.5% of all U.S. deaths in 2019.

The chart below lists the states with the highest mortality rate due to chronic lower respiratory diseases in 2019. It also contains the CDC’s most up-to-date research from 2018 on the percentage of residents who smoke, which has a strong correlation to lung disease.[7] The state ranking is based on the percentage of active smokers in each state.

Key findings include:

  • Kentucky and Oklahoma had the highest chronic lower respiratory disease mortality rate per 100,000 people in 2019.
  • Five of the states with the highest mortality rate due to chronic lower respiratory diseases were also in the top 10 states with the highest rate of current smokers.
  • Six of the states with the highest lung disease mortality rate are in the South.


States with the highest lung disease and smoking rates
State Chronic lower respiratory mortality disease rate per 100,000 people (2019) Percentage of 2018 residents that are active smokers + state ranking
1. Kentucky 62.4 24.6% (2)
2. Oklahoma 62.4 20.1% (12)
3. West Virginia 62.0 26% (1)
4. Arizona 60.2 15.7% (35)
5. Mississippi 56.8 22.2% (6)
6. Indiana 56.1 21.8% (7)
7. Alabama 55.6 20.9% (10)
8. Tennessee 53.2 22.6% (4)
9. Wyoming 51.7 18.7% (17)
10. Montana 50.8 17.2% (24)

States with the highest homicide rate

Despite the nation’s homicide rate being substantially lower than the other main causes of death, it’s a strikingly revealing and informative statistic.

It’s worth noting that the CDC defines homicide as “injuries inflicted by another person with intent to injure or kill, by any means.”[8] Homicide excludes “injuries due to legal intervention and operations of war.” Moreover, homicide is separate from accidents, which can involve car crashes, a residential fire or accidental firearm discharge, to name a few.

Below are the nation’s 10 states with the highest homicide mortality rate and intriguingly related findings:

  • Seven of the states with the highest homicide rate also rank in the top 10 for highest poverty rate.
  • Only two states (Maryland and New Mexico) with the highest homicide rate are outside of the South.
  • Mississippi’s homicide rate is nearly triple the nation’s average homicide rate (5.89).


Homicide rate by state
State Homicide mortality rate per 100,000 people (2019)
1. Mississippi 15.4
2. Louisiana 14.7
3. Alabama 12.8
4. New Mexico 11.8
5. South Carolina 11.0
6. Arkansas 10.8
7. Missouri 10.8
8. Maryland 10.0
9. Arkansas 9.4
10. Tennessee 9.2

States with the lowest life expectancy

Life expectancy is one of the main factors to consider when examining the deadliest states. We determined life expectancy by using the most recent life expectancy data (2018) from the CDC.[9] Based on the U.S. Census regions, the 10 states with the lowest life expectancy are all in the South.[10] Note that the state ranking in the chart below, ranks the poverty rate from 1–50, with the highest poverty rate starting at one.

Two of the main reasons why so many Southern states have such low life expectancy are due to unhealthy lifestyles and lack of routine healthcare. The next section discusses healthy habits nearly anyone can start doing today to improve life expectancy.

States with the worst life expectancy and the highest poverty rate
State 2018 Life expectancy 2019 poverty rate + state ranking
1. West Virginia 74.4 16% (6)
2. Mississippi 74.6 19.6% (1)
3. Alabama 75.1 15.5% (7)
4. Kentucky 75.3 16.3% (4)
5. Tennessee 75.5 13.9% (9)
6. Arkansas 75.6 16.2% (5)
7. Louisiana 75.6 19% (2)
8. Oklahoma 75.6 15.25% (8)
9. South Carolina 76.5 13.8% (10)
10. Missouri 76.6 12.9% (18)

Ways to improve life expectancy

The likelihood of living forever is next to none. We’re not there yet with technology.

That doesn’t mean you should stop considering and planning for the future. One way to help guarantee your loved ones have a safety net when you pass is to get life insurance. You can even get life insurance as a young adult.

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Additionally, part of being an adult also means taking care of your health. Despite not being able to live forever, you can increase your life expectancy in several ways.

Here are five ways to improve your life expectancy:



1. Go outside

According to a recent study, people should spend at least 120 minutes a week outside in nature.[11] While spending time outside, not only is your body absorbing much-needed Vitamin D, but your mental health is likely improving.

It doesn’t matter how these 120 minutes are achieved, just that the total each week is above two hours. You can achieve these outdoor minutes over the weekend or multiple days of the week. If you choose to spend time outside each day of the week, that’s a little under 20 minutes a day outside!

2. Get more exercise

You’ve likely heard this a hundred times from your doctor or high school health teacher: Get more exercise. They wouldn’t keep saying that if it weren’t true.

Exercise doesn’t necessarily mean lifting weights at the gym or hopping on a treadmill. Exercise should mean different things to different people depending on how much activity you need and what your health goals are.

Here are a few creative ways to get more exercise:

  • Do more chores: Doing household chores burns calories.[12] Don’t wait for spring to start cleaning; doing daily chores will help keep your home tidy and your body moving.
  • Purchase smart fitness equipment: If you don’t want to pay for a gym membership or don’t want an additional commute, look into smart fitness equipment. Smart fitness equipment helps make exercise more accessible and affordable. Simply purchasing and wearing a fitness device or tracker can help motivate you to get your steps in.
  • Play pickup sports: Search social media for sports leagues or pickup games that are happening in your area. Many of these leagues are inviting and welcome new players. It’s also a great way to meet new people and to have fun exercising.

3. Quit smoking

Another tip you’ve heard before because it can drastically increase life expectancy is to quit smoking. Tobacco smoking products and electronic cigarettes contain carcinogens and other harmful chemicals.

If it helps, know that you or your loved one are not the only ones trying to quit. In 2019, nearly 23 million Americans tried to quit smoking. Achieving this difficult feat can improve your life expectancy by 10 or more years as well as lower your life insurance premium.[13] 

4. Be social

Humans are social creatures. One of the main factors when it comes to both happiness and living longer is having a strong social community. One study found that having just three social ties may lower your risk of early death by over 200%.[14] 

5. Visit your doctor

One reason life expectancy is lower in the southern part of the United States is due to the lack of healthcare. According to America’s Health Rankings 2019 Annual Report, 9 of the 10 least healthy states are in the South, which falls in line geographically with The Zebra’s findings.[15] 

Part of being a healthy person and extending your life means getting an annual physical, which under most health care plans counts as preventative care and is free.

If you’re concerned about what information you might learn from your annual health screening, it’s best to be in the know rather than putting it off. Also, following the above-mentioned tips can help make your annual physical quick and easy.

Practicing unhealthy habits can not only lower your life expectancy but also takes a toll on your mental and physical health. Residents in these states have a high risk of death for several reasons, but they can decrease many of these risks themselves by performing healthy habits. It’s also ideal to choose a life insurance policy to help prepare for the future.


To uncover the deadliest states in the U.S., The Zebra collected and analyzed the most recent data from the Center for Disease Control and Prevention that has not been affected by the COVID-19 pandemic. We also pulled supplementary data from the U.S. Census Bureau and other peer-reviewed health studies. We weighted and scored all calculations for the final rankings.

Data sources: Statista | Energy Information Administration | CDC 1, 2, 3, 4, 5, 6, 7 | America’s Health Rankings | Nature | Washington Post | NCBI | Healthline | PubMed |

Additional sources
  1. Life expectancy (from birth) in the United States, from 1860 to 2020*.Statista

  2. West Virginia. EIA

  3. Heart Disease Mortality by State. CDC

  4. Adult Obesity Maps. CDC

  5. Stroke Mortality by State. CDC

  6. Chronic Lower Respiratory Disease Mortality by State. CDC

  7. Rates By State. American Lung Association

  8. Web-based Injury Statistics Query and Reporting System (WISQARS™)Fatal Injury Help Menu. CDC

  9. Life Expectancy at Birth by State. CDC

  10. Census Regions and Divisions of the United States. U.S. Census Bureau

  11. Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Scientific Reports

  12. Calories burned in boring household chores can help fight stay-at-home weight gain. The Washington Post

  13. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. National Library of Medicine

  14. Characteristics of socially isolated patients with coronary artery disease who are at elevated risk for mortality. National Library of Medicine

  15. Annual Report 2019. America's Health Rankings