This article was written with the assistance of A.I. technology, and has been edited and fact-checked by Colman Andrews.

Mississippi has the worst adult diabetes rate in the nation at 13.3%, according to data from the Centers for Disease Control and Prevention.

There are several factors that contribute to the high prevalence of diabetes in the United States in general. Obesity is a major risk factor for developing diabetes, and the obesity rate is much higher in the United States than in other developed countries. (Mississippi records a stunning 41.2% adult obesity rate.) Lack of physical activity and poor diet are also significant contributing factors.

According to the CDC, some 36.9% of residents don’t exercise. In addition, Mississippi has the second highest rate of adults with limited access to healthy foods, and the 15th highest rate of adults who sleep less than seven hours per night. These factors, combined with the state’s low median household income, contribute to the high prevalence of diabetes in Mississippi.

As in other Southern states, institutional racism is also a significant factor, as minorities in the South are more likely to be poor and have less access to quality health care.

Click here to see which states have the highest rates of diabetes.