Methodology

To identify the worst cities to live in, 24/7 Wall St. created a weighted index of 25 measures that fall into one of four categories: affordability, economy, quality of life, and community. The city with the worst score in every state was considered the worst city in the state to live in.

In the affordability category, the ratio of the median home value to the median income was given full weight. Cities where the median home value is closer to the median household income were rewarded. Cost of living, as determined by the average cost of goods and services in an area relative to average prices across the nation as a whole, was given a full weight. Property taxes are largely levied at the local level, and cities where residents pay more property taxes as a percentage of their home value were penalized. Property taxes were given a one-quarter weighting.

In the economy category, the unemployment rate was given a full weight. We used five-year average unemployment due to lack of comparable annual data at local levels. Five-year employment growth and the share of the total working-age population with a job were each given a half weight, favoring areas with greater employment and growing job opportunities.

In the quality of life category, the poverty rate was given a full weight, penalizing cities where poverty is more common. The share of the population that struggles to put food on the table due to distance from a grocery store, known as the food insecurity rate, was given full weight. A city’s mortality rate, calculated as the number of people who died while in hospital care per hospital by city, was also given full weight. In cases where city-level data was not available, mortality rates were imputed from county level data.

The drug overdose mortality rate was given a one-quarter weighting, as was the hospital readmission rate, defined as the share of those released from the hospital who were readmitted within 30 days. Distance from the center of the city to the nearest hospital was given full weight, with greater distances penalized.

The number of hospitalizations that would have been prevented by regularly scheduled doctor visits for every 1,000 Medicare enrollees — known as the preventable hospitalization rate — was given half weighting.

Measures used in the community category included the average travel time to work, which was given full weight. The violent crime rate — the total number of rapes, robberies, murders, and aggravated assaults adjusted per 100,000 residents per year— was given full weight. So, too, was the property crime rate, which is the total number of burglaries, larcenies, motor vehicle thefts, and incidents of arson per 100,000 residents per year.

The share of commuters either walking, cycling, or taking public transit to work was given half weight and lower shares were penalized. The total number of restaurants, bars, museums, theater companies, movie theaters, libraries, and parks per capita were each given a one-quarter weighting.

Median household income, median home value, average travel time to work, poverty rate, population, employment-to-population ratio, median property taxes paid, and average unemployment rate are all five-year estimates from the U.S. Census Bureau’s American Community Survey and are for 2017. Overall cost of living is for 2014 and comes from data analysis and aggregation company ATTOM Data Solutions.

The population-adjusted number of entertainment and cultural venues like restaurants and museums comes from the Census Bureau’s County Business Patterns data set and is for 2016.

Violent and property crime rates are from the FBI’s 2017 Uniform Crime Report. Drug overdose mortality rates are from the Centers for Disease Control and Prevention and are for the years 2014 to 2016. Mortality rates and hospital readmission rates are from the Centers for Medicare and Medicaid Services and are as of June 2015. Preventable hospitalizations are from the latest release from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program.