5. Mississippi
> Pct. of working age population with benefits: 7.7%
> Pct. with recurring neck and back pain: 30.3% (23rd lowest)
> 2011 labor force participation rate: 59.6% (4th lowest)
> 2011 unemployment rate: 10.5% (4th highest)

Mississippi had the highest poverty rate in 2011 with 22.6% of residents living below the poverty line. Additionally, the state’s median annual household income that year was the lowest in the nation at slightly less than $37,000. Many residents could not find a job even if they were actively looking. In 2011, Mississippi’s average unemployment rate was the nation’s fourth highest. Additionally, a mere 59.6% of the population participated in the workforce as of 2011, the fourth lowest percentage of all states. Potentially related to the state’s high levels of poverty, as well as obesity, 11.3% of SSDI beneficiaries suffered from a circulatory system disease in December 2011. This was the highest of any state, and well above the 7.7% of beneficiaries nationally.

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4. Kentucky
> Pct. of working age population with benefits: 8.1%
> Pct. with recurring neck and back pain: 34.8% (5th highest)
> 2011 labor force participation rate: 61.5% (10th lowest)
> 2011 unemployment rate: 9.5% (12th highest)

More than 19% of Kentucky’s population lived in poverty in 2011, a higher percentage than all but four states. Many people in Kentucky may not have the means to get well-paying work. Just 83.1% of people have at least a high school diploma, the sixth lowest percentage of all states. Meanwhile, just 21.1% of adults have at least a bachelor’s degree, the fifth lowest percentage of all states. As of 2011, just 61.5% of Kentuckians were considered to be in the labor force, among the lowest rates in the nation. In a well-publicized case, a Kentucky judge, David Daugherty, was accused in a civil suit filed in February of improperly approving Social Security benefits in order to help local attorney Eric Conn, arguably the most prominent disability lawyer in the region, receive millions of dollars from the federal government for handling these cases.

3. Alabama
> Pct. of working age population with benefits: 8.1%
> Pct. with recurring neck and back pain: 34.6% (6th highest)
> 2011 labor force participation rate: 58.5% (2nd lowest)
> 2011 unemployment rate: 8.7% (19th highest)

Alabama was one of the nation’s poorest states as of 2011, with a median annual income of just $41,415. Additionally, educational attainment in the state was limited, with just 82.7% of all residents holding a high school diploma and just 22.3% a college degree in 2011. That year, the state’s average unemployment rate was 8.7%, slightly lower than the U.S. average rate of 8.9% for the year. However, just 58.5% of the population participated in the labor force as of 2011, lower than all states except for West Virginia. In December 2011, SSDI recipients in Alabama were far more likely to receive payments due to diseases of the circulatory system or the musculoskeletal system than recipients in the large majority of other states. Alabamians were among the most likely Americans surveyed in 2012 to state they had experienced a heart attack or were diabetic.

2. Arkansas
> Pct. of working age population with benefits: 8.2%
> Pct. with recurring neck and back pain: 36.1% (2nd highest)
> 2011 labor force participation rate: 60.4% (8th lowest)
> 2011 unemployment rate: 7.9% (24th lowest)

In 2011, the median annual income in Arkansas was just $38,758, the third lowest of all states in the United States. Arkansas is also among the least educated states in the country. Workers with limited education and who are out of work generally have a harder time getting back to work. For instance, just 20.3% of Arkansas residents had at least a bachelor’s degree, lower than all but two other states. An estimated 31.6% of SSDI recipients in Arkansas had musculoskeletal system disease in December 2011, more than any other state except for Alabama. Meanwhile, more than 9% of recipients had diseases involving the circulatory system, higher than all but six other states.

1. West Virginia
> Pct. of working age population with benefits: 9.0%
> Pct. with recurring neck and back pain: 39.0% (the highest)
> 2011 labor force participation rate: 54.1% (the lowest)
> 2011 unemployment rate: 7.8% (23rd lowest)

No state had a higher percentage of working age people receiving SSDI benefits than West Virginia. In addition, the benefits received from by the federal government were more generous compared to most states. The average monthly benefit of more than $1,140 in 2011 was the 10th highest of all states. Almost 21% of recipients received monthly benefits of at least $1,600, a higher percentage than all but three states. Like most states on this list, West Virginia is among the less-educated states in the country. Just 18.5% of the adult population had a bachelor’s degree, the lowest percentage of all states. Also, few residents in the state had jobs. Just 54.1% of residents were considered part of the labor force in 2011, by far the lowest percentage of any state in the nation.

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