Each year, American workers miss more than half a billion days due to illness and injury. While taking a sick day can sometimes not be avoided, a number of studies have shown that certain health conditions and behaviors dramatically increase the likelihood of workers missing work due to illness or disability. These conditions and behaviors include obesity, hypertension, diabetes, and smoking.
Across the country, the prevalence of these factors vary considerably, directly affecting the amount of sick days workers take. While state-level sick day figures are not readily available, 24/7 Wall St. created an index of four measures to approximate the likelihood workers will take a sick day in every state.
To best estimate sick days, rather than the aforementioned conditions, the index comprises factors that directly correlate with missed work. These include self-reported poor mental and physical health, the share of workers on disability, and state-level estimates of the total cost of sick days. States are ranked from the estimated fewest sick days to the most.
Click here to see the states where people are too sick to work.
Click here to see our methodology.
States where we estimate workers miss the most time also have among the highest rates of these conditions, including obesity, diabetes, smoking rates, hypertension, and poor exercise habits.
Missed work is often due to temporary illness. Notably, work absences meaningfully spike during flu season. However, poor health is usually a compounding factor, and those who suffer from many chronic conditions also are more likely to come down with temporary illnesses, such as the flu, and be severely affected by them.
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50. Colorado
> Workers on disability as pct. population: 2.9% (5th lowest)
> Adult obesity rate: 20.5% (the lowest)
> Adult smoking rate: 15.6% (17th lowest)
> Avg. physically unhealthy days per month: 3.4 (9th fewest)
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49. Hawaii
> Workers on disability as pct. population: 2.5% (the lowest)
> Adult obesity rate: 22.3% (2nd lowest)
> Adult smoking rate: 13.1% (3rd lowest)
> Avg. physically unhealthy days per month: 3.4 (10th fewest)
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48. Utah
> Workers on disability as pct. population: 2.6% (3rd lowest)
> Adult obesity rate: 25.3% (10th lowest)
> Adult smoking rate: 8.8% (the lowest)
> Avg. physically unhealthy days per month: 3.4 (8th fewest)
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47. South Dakota
> Workers on disability as pct. population: 3.7% (16th lowest)
> Adult obesity rate: 30.6% (18th highest)
> Adult smoking rate: 18.1% (19th highest)
> Avg. physically unhealthy days per month: 3.1 (5th fewest)
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46. North Dakota
> Workers on disability as pct. population: 3.0% (6th lowest)
> Adult obesity rate: 31.8% (12th highest)
> Adult smoking rate: 19.8% (13th highest)
> Avg. physically unhealthy days per month: 3.0 (3rd fewest)
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45. California
> Workers on disability as pct. population: 2.8% (4th lowest)
> Adult obesity rate: 22.7% (3rd lowest)
> Adult smoking rate: 11.0% (2nd lowest)
> Avg. physically unhealthy days per month: 3.5 (15th fewest)
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44. Montana
> Workers on disability as pct. population: 4.4% (24th lowest)
> Adult obesity rate: 25.0% (8th lowest)
> Adult smoking rate: 18.5% (18th highest)
> Avg. physically unhealthy days per month: 3.6 (21st fewest)
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43. Minnesota
> Workers on disability as pct. population: 3.7% (14th lowest)
> Adult obesity rate: 27.3% (18th lowest)
> Adult smoking rate: 15.2% (14th lowest)
> Avg. physically unhealthy days per month: 3.0 (2nd fewest)
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42. Nebraska
> Workers on disability as pct. population: 3.6% (13th lowest)
> Adult obesity rate: 30.7% (17th highest)
> Adult smoking rate: 17.0% (24th lowest)
> Avg. physically unhealthy days per month: 3.2 (7th fewest)
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41. Idaho
> Workers on disability as pct. population: 4.5% (25th highest)
> Adult obesity rate: 28.6% (24th lowest)
> Adult smoking rate: 14.5% (12th lowest)
> Avg. physically unhealthy days per month: 3.7 (23rd fewest)
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40. Texas
> Workers on disability as pct. population: 3.3% (7th lowest)
> Adult obesity rate: 28.4% (22nd lowest)
> Adult smoking rate: 14.3% (10th lowest)
> Avg. physically unhealthy days per month: 3.5 (17th fewest)
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39. Arizona
> Workers on disability as pct. population: 3.7% (17th lowest)
> Adult obesity rate: 26.7% (13th lowest)
> Adult smoking rate: 14.7% (13th lowest)
> Avg. physically unhealthy days per month: 4.0 (15th most)
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38. Florida
> Workers on disability as pct. population: 4.5% (23rd highest)
> Adult obesity rate: 25.9% (12th lowest)
> Adult smoking rate: 15.5% (16th lowest)
> Avg. physically unhealthy days per month: 3.8 (20th most)
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37. Wyoming
> Workers on disability as pct. population: 3.7% (15th lowest)
> Adult obesity rate: 28.5% (23rd lowest)
> Adult smoking rate: 19.0% (16th highest)
> Avg. physically unhealthy days per month: 3.8 (23rd most)
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36. Iowa
> Workers on disability as pct. population: 4.1% (21st lowest)
> Adult obesity rate: 31.8% (12th highest)
> Adult smoking rate: 16.7% (22nd lowest)
> Avg. physically unhealthy days per month: 2.9 (the fewest)
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35. Alaska
> Workers on disability as pct. population: 2.6% (2nd lowest)
> Adult obesity rate: 29.4% (24th highest)
> Adult smoking rate: 19.0% (16th highest)
> Avg. physically unhealthy days per month: 3.8 (24th most)
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34. New York
> Workers on disability as pct. population: 4.0% (20th lowest)
> Adult obesity rate: 25.0% (8th lowest)
> Adult smoking rate: 14.2% (9th lowest)
> Avg. physically unhealthy days per month: 3.6 (20th fewest)
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33. Oregon
> Workers on disability as pct. population: 4.3% (23rd lowest)
> Adult obesity rate: 27.2% (17th lowest)
> Adult smoking rate: 16.2% (19th lowest)
> Avg. physically unhealthy days per month: 3.8 (19th most)
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32. Kansas
> Workers on disability as pct. population: 4.2% (22nd lowest)
> Adult obesity rate: 32.4% (8th highest)
> Adult smoking rate: 17.2% (25th highest)
> Avg. physically unhealthy days per month: 3.1 (6th fewest)
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31. Washington
> Workers on disability as pct. population: 3.9% (18th lowest)
> Adult obesity rate: 27.0% (15th lowest)
> Adult smoking rate: 14.0% (8th lowest)
> Avg. physically unhealthy days per month: 3.7 (25th fewest)
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30. Vermont
> Workers on disability as pct. population: 5.7% (10th highest)
> Adult obesity rate: 24.7% (6th lowest)
> Adult smoking rate: 17.0% (24th lowest)
> Avg. physically unhealthy days per month: 3.6 (18th fewest)
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29. Massachusetts
> Workers on disability as pct. population: 4.6% (22nd highest)
> Adult obesity rate: 24.3% (4th lowest)
> Adult smoking rate: 13.6% (5th lowest)
> Avg. physically unhealthy days per month: 3.4 (13th fewest)
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28. Nevada
> Workers on disability as pct. population: 3.6% (11th lowest)
> Adult obesity rate: 26.8% (14th lowest)
> Adult smoking rate: 16.5% (20th lowest)
> Avg. physically unhealthy days per month: 4.3 (9th most)
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27. Illinois
> Workers on disability as pct. population: 3.6% (9th lowest)
> Adult obesity rate: 28.0% (20th lowest)
> Adult smoking rate: 15.8% (18th lowest)
> Avg. physically unhealthy days per month: 3.8 (25th most)
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26. Maryland
> Workers on disability as pct. population: 3.4% (8th lowest)
> Adult obesity rate: 29.2% (25th highest)
> Adult smoking rate: 13.7% (6th lowest)
> Avg. physically unhealthy days per month: 3.1 (4th fewest)
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25. New Jersey
> Workers on disability as pct. population: 3.6% (10th lowest)
> Adult obesity rate: 25.9% (12th lowest)
> Adult smoking rate: 14.0% (8th lowest)
> Avg. physically unhealthy days per month: 3.5 (16th fewest)
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24. Connecticut
> Workers on disability as pct. population: 3.6% (12th lowest)
> Adult obesity rate: 25.2% (9th lowest)
> Adult smoking rate: 13.4% (4th lowest)
> Avg. physically unhealthy days per month: 3.4 (12th fewest)
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23. Virginia
> Workers on disability as pct. population: 4.0% (19th lowest)
> Adult obesity rate: 28.3% (21st lowest)
> Adult smoking rate: 15.3% (15th lowest)
> Avg. physically unhealthy days per month: 3.5 (14th fewest)
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22. Georgia
> Workers on disability as pct. population: 4.4% (25th lowest)
> Adult obesity rate: 30.2% (21st highest)
> Adult smoking rate: 17.9% (22nd highest)
> Avg. physically unhealthy days per month: 3.8 (21st most)
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21. Wisconsin
> Workers on disability as pct. population: 4.5% (24th highest)
> Adult obesity rate: 30.6% (18th highest)
> Adult smoking rate: 17.1% (25th lowest)
> Avg. physically unhealthy days per month: 3.6 (22nd fewest)
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20. North Carolina
> Workers on disability as pct. population: 5.2% (17th highest)
> Adult obesity rate: 29.6% (22nd highest)
> Adult smoking rate: 17.9% (22nd highest)
> Avg. physically unhealthy days per month: 3.6 (19th fewest)
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19. Delaware
> Workers on disability as pct. population: 4.7% (21st highest)
> Adult obesity rate: 30.6% (18th highest)
> Adult smoking rate: 17.7% (24th highest)
> Avg. physically unhealthy days per month: 3.4 (11th fewest)
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18. Rhode Island
> Workers on disability as pct. population: 5.5% (13th highest)
> Adult obesity rate: 27.2% (17th lowest)
> Adult smoking rate: 14.4% (11th lowest)
> Avg. physically unhealthy days per month: 3.8 (22nd most)
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17. New Mexico
> Workers on disability as pct. population: 5.2% (16th highest)
> Adult obesity rate: 24.4% (5th lowest)
> Adult smoking rate: 16.6% (21st lowest)
> Avg. physically unhealthy days per month: 4.3 (8th most)
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16. Indiana
> Workers on disability as pct. population: 5.1% (19th highest)
> Adult obesity rate: 32.0% (10th highest)
> Adult smoking rate: 21.1% (10th highest)
> Avg. physically unhealthy days per month: 3.9 (17th most)
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15. Ohio
> Workers on disability as pct. population: 5.0% (20th highest)
> Adult obesity rate: 31.6% (15th highest)
> Adult smoking rate: 22.5% (6th highest)
> Avg. physically unhealthy days per month: 4.0 (16th most)
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14. Pennsylvania
> Workers on disability as pct. population: 5.1% (18th highest)
> Adult obesity rate: 29.6% (22nd highest)
> Adult smoking rate: 18.0% (20th highest)
> Avg. physically unhealthy days per month: 3.9 (18th most)
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13. New Hampshire
> Workers on disability as pct. population: 5.7% (11th highest)
> Adult obesity rate: 27.9% (19th lowest)
> Adult smoking rate: 18.0% (20th highest)
> Avg. physically unhealthy days per month: 3.7 (24th fewest)
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12. Maine
> Workers on disability as pct. population: 7.1% (6th highest)
> Adult obesity rate: 29.0% (25th lowest)
> Adult smoking rate: 19.8% (13th highest)
> Avg. physically unhealthy days per month: 4.2 (11th most)
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11. Missouri
> Workers on disability as pct. population: 5.8% (8th highest)
> Adult obesity rate: 31.8% (12th highest)
> Adult smoking rate: 22.1% (7th highest)
> Avg. physically unhealthy days per month: 4.2 (12th most)
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10. Michigan
> Workers on disability as pct. population: 5.6% (12th highest)
> Adult obesity rate: 31.3% (16th highest)
> Adult smoking rate: 20.4% (11th highest)
> Avg. physically unhealthy days per month: 4.3 (10th most)
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9. South Carolina
> Workers on disability as pct. population: 5.8% (9th highest)
> Adult obesity rate: 32.0% (10th highest)
> Adult smoking rate: 20.0% (12th highest)
> Avg. physically unhealthy days per month: 4.2 (13th most)
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8. Tennessee
> Workers on disability as pct. population: 6.1% (7th highest)
> Adult obesity rate: 32.4% (8th highest)
> Adult smoking rate: 22.1% (7th highest)
> Avg. physically unhealthy days per month: 4.4 (5th most)
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7. Oklahoma
> Workers on disability as pct. population: 5.3% (15th highest)
> Adult obesity rate: 33.2% (7th highest)
> Adult smoking rate: 19.6% (15th highest)
> Avg. physically unhealthy days per month: 4.5 (4th most)
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6. Louisiana
> Workers on disability as pct. population: 5.4% (14th highest)
> Adult obesity rate: 34.7% (3rd highest)
> Adult smoking rate: 22.8% (4th highest)
> Avg. physically unhealthy days per month: 4.1 (14th most)
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5. Alabama
> Workers on disability as pct. population: 7.7% (2nd highest)
> Adult obesity rate: 34.7% (3rd highest)
> Adult smoking rate: 21.5% (9th highest)
> Avg. physically unhealthy days per month: 4.4 (6th most)
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4. Kentucky
> Workers on disability as pct. population: 7.4% (4th highest)
> Adult obesity rate: 33.7% (6th highest)
> Adult smoking rate: 24.5% (2nd highest)
> Avg. physically unhealthy days per month: 4.8 (3rd most)
Source: SeanPavonePhoto / Getty Images
3. Mississippi
> Workers on disability as pct. population: 7.1% (5th highest)
> Adult obesity rate: 35.3% (2nd highest)
> Adult smoking rate: 22.7% (5th highest)
> Avg. physically unhealthy days per month: 4.4 (7th most)
Source: Sean Pavone / Getty Images
2. Arkansas
> Workers on disability as pct. population: 7.7% (3rd highest)
> Adult obesity rate: 34.6% (5th highest)
> Adult smoking rate: 23.6% (3rd highest)
> Avg. physically unhealthy days per month: 5.0 (2nd most)
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1. West Virginia
> Workers on disability as pct. population: 8.0% (the highest)
> Adult obesity rate: 35.5% (the highest)
> Adult smoking rate: 24.8% (the highest)
> Avg. physically unhealthy days per month: 5.2 (the most)
Methodology:
To determine the states where people are too sick to work, 24/7 Wall St. created an index of four measures closely tied with work absenteeism due to illness or injury.
Two of the index components are the average number of days of poor mental and physical health as reported by adults. These figures came from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program.
The index also includes the estimated state-level cost of missed work due to illness or injury per worker. 24/7 Wall St. estimated the total state level cost of absenteeism based on the findings of a 2015 study published in the Journal of Occupational and Environmental Medicine, “State-Level Estimates of Obesity-Attributable Costs of Absenteeism.” Labor force data used in our calculation is for 2017 and comes from the U.S. Bureau of Labor Statistics. For our index, we divided the estimated total cost of absenteeism by state by the labor force for that state.
The final component in our index is the number of workers receiving disability as a share of the population. This is a 24/7 Wall St. calculation based on 2016 disability recipiency rates and population figures published by the U.S. Social Security Administration. In our index, days of poor mental health and poor physical health each received half rank, and cost of sick days per worker and workers receiving disability as a share of the population each received full weight.
Not included in our index but considered for the story are the adult obesity rate, which is from County Health Rankings, and the adult smoking rate, which is from the CDC’s Behavioral Risk Factor Surveillance System. All figures listed are for the most recent available year.
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