Methodology: 

To identify the worst cities to live in, 24/7 Wall St. created a weighted index of 25 measures across four categories: affordability, economy, quality of life, and community.

1.) The affordability category consists of three measures:

• The ratio of median home value to median household income, at one-fourth weight.
• Median property taxes paid as a percentage of median home value, at one-fourth weight.
• Regional price parity, a measure of cost of living, at one-fourth weight.

2.) The economy category consists of four measures:

• Median home value, at full weight.
• Employment growth from 2014 to 2018, at one-half weight.
• The ratio of the number of employed workers to the total population, at one-half weight.
• The unemployment rate, at triple weight.

3.) The quality of life category consists of six measures:

• The poverty rate, at four times weight.
• The share of the population in urban census tracts at least 1 mile from a grocery store and in rural census tracts at least 10 miles from a grocery store, a measure of poor food access, at full weight.
• The distance from the city center to the nearest hospital, at full weight.
• The percentage of patients discharged from acute care hospitals who are readmitted to the hospital within 30 days, at one-fourth weight.
• The percentage of heart attack, coronary artery bypass grafting (CABG) surgery, chronic obstructive pulmonary disease (COPD), heart failure, pneumonia, and stroke patients who pass away within 30 days of treatment, at full weight.
• The number of drug-related fatalities per 100,000 residents, at double weight.

4.) The community category consists of 12 measures:

• The percentage of workers 16 and over commuting by public transit, walking, or other non-car means, at one-half weight.
• The average travel time to work, at one-fourth weight.
• The number of hospital admissions for conditions that could be treated in an outpatient setting per 1,000 Medicare enrollees — an indication of poor outpatient care and overuse of hospitals — at one-half weight.
• The number of violent crimes — homicide, rape, robbery, and aggravated assault — reported per 100,000 residents, at full weight.
• The number of property crimes — burglary, larceny, motor vehicle theft, and arson — reported per 100,000 residents, at full weight.
• The number of movie theaters per 100,000 residents, at one-tenth weight.
• The number of libraries and archives per 100,000 residents, at one-tenth weight.
• The number of theater companies and dinner theaters per 100,000 residents, at one-tenth weight.
• The number of museums per 100,000 residents, at one-tenth weight.
• The number of nature parks and similar institutions per 100,000 residents, at one-tenth weight.
• The number of alcoholic drinking places per 100,000 residents, at one-tenth weight.
• The number of restaurants and other eating places per 100,000 residents, at one-tenth weight.

Data on population, employment, unemployment, median home value, median household income, median property taxes paid, commuter characteristics, average travel time to work, and poverty came from the U.S. Census Bureau’s American Community Survey and are five-year estimates for the period 2014 to 2018. Employment data used to calculate five-year employment growth are five-year estimates for the years 2010 to 2014. Data on cost of living came from real estate analysis company ATTOM Data Solutions and is for the year 2014.

Data on the share of the population in urban census tracts or areas at least 1 mile from a grocery store and in rural census tracts at least 10 miles from a grocery store, a measure of poor food access, came from the U.S. Department of Agriculture’s 2017 update to the Food Access Research Atlas and is at the county level.

Data on hospital locations came from the Centers for Medicare & Medicaid Services. Data on 30-day readmission rates and 30-day mortality rates also came from the CMS and are for the period July 2016 to June 2019. Data was aggregated to the city level for cities with at least one hospital, and was aggregated to the county level for cities with no hospitals. Data on the number of drug-related deaths per 100,000 residents per year from the period 2016 to 2018 is from the Centers for Disease Control and Prevention and is at the county level. Data on preventable hospitalizations per 1,000 Medicare enrollees came from the 2020 County Health Rankings and Roadmaps program, a collaboration between the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute, and is at the county level.

Data on the number of violent crimes and property crimes reported per 100,000 residents came from the FBI’s Uniform Crime Reporting Program and are for the year 2018.

Data on the number of movie theaters, libraries and archives, theater companies and dinner theaters, museums, nature parks and other similar institutions, alcoholic beverage drinking places, and restaurants and other eating places came from the Census Bureau’s 2018 County Business Patterns series and is at the county level.

To avoid geographic clustering, we only took the lowest-ranking city in a given county. Our list includes cities, towns, villages, boroughs, and Census designated places. We did not include places with fewer than 8,000 residents in our analysis. We also excluded places with more than 20% enrollment in college and graduate school as well as places where more than 20% of the population is employed in the armed forces, based on five-year data from the 2018 ACS.