Special Report

States With the Most Premature Death

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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