With the exception of the small European country of Monaco, the United States has more cars per capita than every other country in the world. For better or worse, the United States is a country uniquely dependent on the personal automobile. Driving, while a practical necessity for millions of Americans, can also be a financial burden, a major cause of stress — and also a dangerous activity.

On every road in the country, driving comes with a set of inherent risks and costs. Congested roads, high gas prices, and fatal collisions caused by distracted or drunk drivers are but a few. While drivers accept these road conditions, potential hazards, and costs when they get behind the wheel, not all cities are equally safe or congested, and some are certainly more expensive for drivers than others.

24/7 Wall St. created an index composed of several driving-related measures to identify the worst metropolitan statistical area to drive in each state. The components of the index — which include average commute time, gas prices, and accident rates — were selected to capture an area’s safety, convenience, and cost of driving.

Just because a metro area ranks as the worst place to drive in a given state does not necessarily mean it compares poorly to the nation as a whole. For example, 21 cities on this list have a lower per capita roadway fatality rate than the national rate of 11.4 deaths per 100,000 Americans. The cities on this list in Delaware, New Hampshire, Rhode Island, and Vermont also rank as the worst by default as they are the only metro area in the state.

Click here to read about the worst cities to drive in every state.

To identify the worst cities to drive in every state, 24/7 Wall St. created an index based on measures of safety, cost, and the convenience of driving, normalized to be comparable with one another. Total fatalities and traffic fatalities involving drunk drivers per 100,000, is from the Fatality Analysis Reporting System (FARS) for 2017. Mean travel time to work and the percentage of the working-age population with a commute of 60 minutes or longer came from the American Community Survey (ACS) 2017 1-year estimates. The rate of car theft per 100,000 people is from the National Insurance Crime Bureau (NICB) Hot Spots report for the year 2017. The average price of gasoline from Q2 2017 to Q2 2018 is from the Council for Community and Economic Research’s (C2ER) cost of living index for metropolitan statistical areas.