The Most Surprising (Yet) Common Causes of Death [All 50 States + DC]

Surgeons performing surgery in operating Theater.

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Advances in medicine and technology have led to decades of rising life expectancy in the U.S. However, according to the Centers for Disease Control and Prevention, life expectancy at birth in the U.S. was 78.6 years in 2017, down from 78.7 years in 2016.

Though it may seem small, this notable decline marks the third consecutive year that life expectancy at birth has fallen and represents an alarming national trend.

While common physical health conditions like heart disease and cancer still claim the majority of lives in the U.S. each year, accidental deaths from overdoses and intentional deaths by suicide are largely responsible for rising mortality rates nationwide.

15 leading causes of death in US

Despite representing a smaller percentage of total deaths compared to other major health conditions, death rates due to suicide and accidents have skyrocketed over the past two decades. In 2017, the suicide death rate per 100,000 people was 14.5, an increase of 33 percent from the rate of 10.8 in 1999. Over the same time period, the death rate due to accidents increased from 37.2 per 100,000 to 52.2. Accidents are defined as unintentional injuries, which include alcohol and drug overdoses.

line graphs showing Increased suicide and accident mortality

According to the CDC, 70,327 deaths in 2017 were the result of drug overdoses, with about two-thirds related to opioids. This represents a 9.6 percent increase in the age-adjusted death rate from 2016.

The states with the highest rates of drug overdose deaths are West Virginia (57.8 per 100,000), Ohio (46.3 per 100,000), Pennsylvania (44.3 per 100,000), the District of Columbia (44.0 per 100,000), and Kentucky (37.2 per 100,000).

Overall, mortality rates also vary significantly by state. There is a clear geographical cluster of high mortality rates for states along the Ohio and Mississippi Rivers. More specifically, eight states in the Southeast, including West Virginia, Mississippi, Alabama, and Tennessee have age-adjusted mortality rates exceeding 1,000 per 100,000 people. By contrast, the lowest mortality rates are in California and Hawaii at 734.1 and 688.2 respectively.

heat map showing mortality rates by US state

There is a significant relationship between high mortality rates and low median incomes among U.S. states. For example, Mississippi, Louisiana, Arkansas, and West Virginia have median household incomes below $50,000 as well as mortality rates in excess of 1,000 per 100,000. California and Hawaii, which have median household incomes around $70,000, have mortality rates under 750 per 100,000.

plot graph showing median income vs mortality rates

The other major geographic trend related to mortality rates is a clear cluster of high suicide rates in Alaska and the Rocky Mountain region, which has been labeled “the suicide belt.” In 2017, the suicide rate was highest in Montana, at a rate of 29.7 deaths per 100,000 people, and lowest in Washington D.C., at 6.7 deaths per 100,000.


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In general, suicide rates are significantly lower on the East Coast and in California. Research from the CDC shows that suicide is particularly prevalent among young people and became the second-leading cause of death for Americans aged 10-34 in 2016. The same CDC report indicates that in 2017, the suicide rate in rural counties was 1.8 times higher than the suicide rate in urban counties, a differential that had also increased since 1999.

heat map showing suicide rate by state

To find out how major causes of death vary around the country, our researchers calculated the most surprising cause of death in each state, using 2017 data from the CDC WONDER Online Database. For the top 15 leading causes of death nationally, we compared each state’s age-adjusted mortality rate to the national mortality rate for that cause.

Whichever cause exceeded its respective national mortality rate by the greatest amount, was identified as the most over-indexed cause of death in that state.

The most over-indexed cause of death represents a disproportionately high death rate within the state relative to the national rate. Here is the full state-by-state analysis.

The Most Surprising Common Cause of Death in Every State

Alabama_Montgomery

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#1 – Alabama

  • Most over-indexed cause of death: Septicemia
  • State age-adjusted death rate for the cause: 20.8 deaths per 100,000 people
  • State total number of deaths per year for the cause: 1,036
  • State percentage of total deaths for the cause: 1.95%
Alaska capitol building

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#2 – Alaska

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 27.5 deaths per 100,000 people
  • State total number of deaths per year for the cause: 200
  • State percentage of total deaths for the cause: 4.53%
Phoenix, Arizona capitol

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#3 – Arizona

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 19.1 deaths per 100,000 people
  • State total number of deaths per year for the cause: 1,327
  • State percentage of total deaths for the cause: 2.30%
Arkansas capitol

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#4 – Arkansas

  • Most over-indexed cause of death: Chronic lower respiratory diseases
  • State age-adjusted death rate for the cause: 80.6 deaths per 100,000 people
  • State total number of deaths per year for the cause: 2,517
  • State percentage of total deaths for the cause: 7.72%
California Sacramento state capitol

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#5 – California

  • Most over-indexed cause of death: Essential hypertension and hypertensive renal disease
  • State age-adjusted death rate for the cause: 15.4 deaths per 100,000 people
  • State total number of deaths per year for the cause: 5,596
  • State percentage of total deaths for the cause: 2.09%
Colorado Denver state capitol

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#6 – Colorado

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 21 deaths per 100,000 people
  • State total number of deaths per year for the cause: 1,181
  • State percentage of total deaths for the cause: 3.10%
Connecticut capitol

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#7 – Connecticut

  • Most over-indexed cause of death: Pneumonitis due to solids and liquids
  • State age-adjusted death rate for the cause: 9.2 deaths per 100,000 people
  • State total number of deaths per year for the cause: 392
  • State percentage of total deaths for the cause: 1.25%
Delaware capitol

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#8 – Delaware

  • Most over-indexed cause of death: Nephritis, nephrotic syndrome and nephrosis
  • State age-adjusted death rate for the cause: 19.5 deaths per 100,000 people
  • State total number of deaths per year for the cause: 205
  • State percentage of total deaths for the cause: 2.23%
District of Columbia

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#9 – District of Columbia

  • Most over-indexed cause of death: Accidents (unintentional injuries)
  • State age-adjusted death rate for the cause: 70.2 deaths per 100,000 people
  • State total number of deaths per year for the cause: 427
  • State percentage of total deaths for the cause: 8.60%
allahassee, Florida, USA at the historic Florida State Capitol Building.

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#10 – Florida

  • Most over-indexed cause of death: Accidents (unintentional injuries)
  • State age-adjusted death rate for the cause: 58.4 deaths per 100,000 people
  • State total number of deaths per year for the cause: 13,059
  • State percentage of total deaths for the cause: 6.41%
Georgia State Capitol building in Atlanta. Image shot 08/2013. Exact date unknown.

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#11 – Georgia

  • Most over-indexed cause of death: Septicemia
  • State age-adjusted death rate for the cause: 18.1 deaths per 100,000 people
  • State total number of deaths per year for the cause: 1,611
  • State percentage of total deaths for the cause: 1.94%
Hawaii_capitol

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#12 – Hawaii

  • Most over-indexed cause of death: Influenza and pneumonia
  • State age-adjusted death rate for the cause: 35.8 deaths per 100,000 people
  • State total number of deaths per year for the cause: 637
  • State percentage of total deaths for the cause: 5.59%
Boise, Idaho USA capitol boulevard building

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#13 – Idaho

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 23.7 deaths per 100,000 people
  • State total number of deaths per year for the cause: 392
  • State percentage of total deaths for the cause: 2.80%
Illinois capitol

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#14 – Illinois

  • Most over-indexed cause of death: Nephritis, nephrotic syndrome and nephrosis
  • State age-adjusted death rate for the cause: 20 deaths per 100,000 people
  • State total number of deaths per year for the cause: 2,565
  • State percentage of total deaths for the cause: 2.34%
Indiana state capitol building in Indianapolis

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#15 – Indiana

  • Most over-indexed cause of death: Septicemia
  • State age-adjusted death rate for the cause: 19.4 deaths per 100,000 people
  • State total number of deaths per year for the cause: 1,277
  • State percentage of total deaths for the cause: 1.95%
Iowa_Des_Moines_Capitol

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#16 – Iowa

  • Most over-indexed cause of death: Chronic lower respiratory diseases
  • State age-adjusted death rate for the cause: 55.7 deaths per 100,000 people
  • State total number of deaths per year for the cause: 1,939
  • State percentage of total deaths for the cause: 6.35%
Kansas State Capitol located in Topeka, Kansas, USA.

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#17 – Kansas

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 19.4 deaths per 100,000 people
  • State total number of deaths per year for the cause: 553
  • State percentage of total deaths for the cause: 2.04%
Kentucky capitol

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#18 – Kentucky

  • Most over-indexed cause of death: Septicemia
  • State age-adjusted death rate for the cause: 22 deaths per 100,000 people
  • State total number of deaths per year for the cause: 979
  • State percentage of total deaths for the cause: 2.03%

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Louisiana Baton Rouge capitol

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#19 – Louisiana

  • Most over-indexed cause of death: Septicemia
  • State age-adjusted death rate for the cause: 24.4 deaths per 100,000 people
  • State total number of deaths per year for the cause: 1,080
  • State percentage of total deaths for the cause: 2.36%
Maine capitol

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#20 – Maine

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 19.5 deaths per 100,000 people
  • State total number of deaths per year for the cause: 274
  • State percentage of total deaths for the cause: 1.87%
Maryland Annapolis capitol

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#21 – Maryland

  • Most over-indexed cause of death: Septicemia
  • State age-adjusted death rate for the cause: 14.9 deaths per 100,000 people
  • State total number of deaths per year for the cause: 882
  • State percentage of total deaths for the cause: 1.77%
Massachusetts Boston state capitol

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#22 – Massachusetts

  • Most over-indexed cause of death: Pneumonitis due to solids and liquids
  • State age-adjusted death rate for the cause: 7.7 deaths per 100,000 people
  • State total number of deaths per year for the cause: 581
  • State percentage of total deaths for the cause: 0.99%
Michigan Lansing capitol

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#23 – Michigan

  • Most over-indexed cause of death: Diseases of heart
  • State age-adjusted death rate for the cause: 236.5 deaths per 100,000 people
  • State total number of deaths per year for the cause: 25,187
  • State percentage of total deaths for the cause: 25.81%
St. Paul state capital building

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#24 – Minnesota

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 14.2 deaths per 100,000 people
  • State total number of deaths per year for the cause: 783
  • State percentage of total deaths for the cause: 1.76%
Mississippi Jackson capitol

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#25 – Mississippi

  • Most over-indexed cause of death: Essential hypertension and hypertensive renal disease
  • State age-adjusted death rate for the cause: 19.2 deaths per 100,000 people
  • State total number of deaths per year for the cause: 551
  • State percentage of total deaths for the cause: 1.71%
Missouri Jefferson City capitol

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#26 – Missouri

  • Most over-indexed cause of death: Nephritis, nephrotic syndrome and nephrosis
  • State age-adjusted death rate for the cause: 23.5 deaths per 100,000 people
  • State total number of deaths per year for the cause: 1,515
  • State percentage of total deaths for the cause: 2.45%
Montana_capitol

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#27 – Montana

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 29.7 deaths per 100,000 people
  • State total number of deaths per year for the cause: 311
  • State percentage of total deaths for the cause: 3.05%
Nebraska State Capitol, Lincoln, Nebraska, United States of America, North America

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#28 – Nebraska

  • Most over-indexed cause of death: Chronic lower respiratory diseases
  • State age-adjusted death rate for the cause: 62.9 deaths per 100,000 people
  • State total number of deaths per year for the cause: 1,224
  • State percentage of total deaths for the cause: 7.25%
Nevada_capitol_Carson-City

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#29 – Nevada

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 21.2 deaths per 100,000 people
  • State total number of deaths per year for the cause: 627
  • State percentage of total deaths for the cause: 2.54%
The state house capital building of New Hampshire is located in the city of Concord, NH, USA with surrounding grounds.

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#30 – New Hampshire

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 19.2 deaths per 100,000 people
  • State total number of deaths per year for the cause: 265
  • State percentage of total deaths for the cause: 2.12%
New Jersey capitol

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#31 – New Jersey

  • Most over-indexed cause of death: Septicemia
  • State age-adjusted death rate for the cause: 20 deaths per 100,000 people
  • State total number of deaths per year for the cause: 1,898
  • State percentage of total deaths for the cause: 2.54%
State Capital Building in Santa Fe, New Mexico USA.

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#32 – New Mexico

  • Most over-indexed cause of death: Chronic liver disease and cirrhosis
  • State age-adjusted death rate for the cause: 29.3 deaths per 100,000 people
  • State total number of deaths per year for the cause: 605
  • State percentage of total deaths for the cause: 3.24%
The State government buildings in Albany, New York

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#33 – New York

  • Most over-indexed cause of death: Influenza and pneumonia
  • State age-adjusted death rate for the cause: 21.1 deaths per 100,000 people
  • State total number of deaths per year for the cause: 4,517
  • State percentage of total deaths for the cause: 2.91%
North Carolina Raleigh capitol

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#34 – North Carolina

  • Most over-indexed cause of death: Nephritis, nephrotic syndrome and nephrosis
  • State age-adjusted death rate for the cause: 20.3 deaths per 100,000 people
  • State total number of deaths per year for the cause: 2,040
  • State percentage of total deaths for the cause: 2.19%

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State Capitol of North Dakota, Bismarck

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#35 – North Dakota

  • Most over-indexed cause of death: Pneumonitis due to solids and liquids
  • State age-adjusted death rate for the cause: 10.4 deaths per 100,000 people
  • State total number of deaths per year for the cause: 86
  • State percentage of total deaths for the cause: 1.34%
Ohio State Capitol Building, Columbus

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#36 – Ohio

  • Most over-indexed cause of death: Accidents (unintentional injuries)
  • State age-adjusted death rate for the cause: 76.5 deaths per 100,000 people
  • State total number of deaths per year for the cause: 8,971
  • State percentage of total deaths for the cause: 7.26%
Oklahoma capitol

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#37 – Oklahoma

  • Most over-indexed cause of death: Chronic lower respiratory diseases
  • State age-adjusted death rate for the cause: 79.4 deaths per 100,000 people
  • State total number of deaths per year for the cause: 3,035
  • State percentage of total deaths for the cause: 7.50%
Oregon State Capitol Building

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#38 – Oregon

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 19.6 deaths per 100,000 people
  • State total number of deaths per year for the cause: 825
  • State percentage of total deaths for the cause: 2.25%
Capitol Building Harrisburg, Pennsylvania

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#39 – Pennsylvania

  • Most over-indexed cause of death: Accidents (unintentional injuries)
  • State age-adjusted death rate for the cause: 71.6 deaths per 100,000 people
  • State total number of deaths per year for the cause: 9,527
  • State percentage of total deaths for the cause: 7.02%
Rhode island capitol

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#40 – Rhode Island

  • Most over-indexed cause of death: Accidents (unintentional injuries)
  • State age-adjusted death rate for the cause: 63.3 deaths per 100,000 people
  • State total number of deaths per year for the cause: 718
  • State percentage of total deaths for the cause: 7.07%
South Carolina capitol

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#41 – South Carolina

  • Most over-indexed cause of death: Septicemia
  • State age-adjusted death rate for the cause: 17.2 deaths per 100,000 people
  • State total number of deaths per year for the cause: 884
  • State percentage of total deaths for the cause: 1.79%
Sunrise lights up the capitol dome in Pierre, SD

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#42 – South Dakota

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 22.6 deaths per 100,000 people
  • State total number of deaths per year for the cause: 191
  • State percentage of total deaths for the cause: 2.39%
Tennessee capitol

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#43 – Tennessee

  • Most over-indexed cause of death: Influenza and pneumonia
  • State age-adjusted death rate for the cause: 25.2 deaths per 100,000 people
  • State total number of deaths per year for the cause: 1,656
  • State percentage of total deaths for the cause: 2.36%
Texas Austin state capitol

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#44 – Texas

  • Most over-indexed cause of death: Septicemia
  • State age-adjusted death rate for the cause: 18.8 deaths per 100,000 people
  • State total number of deaths per year for the cause: 4,268
  • State percentage of total deaths for the cause: 2.15%
Utah Salt Lake City

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#45 – Utah

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 23 deaths per 100,000 people
  • State total number of deaths per year for the cause: 663
  • State percentage of total deaths for the cause: 3.68%
Vermont capitol

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#46 – Vermont

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 18 deaths per 100,000 people
  • State total number of deaths per year for the cause: 112
  • State percentage of total deaths for the cause: 1.86%
Richmond, Virginia, USA at the Capitol Building.

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#47 – Virginia

  • Most over-indexed cause of death: Nephritis, nephrotic syndrome and nephrosis
  • State age-adjusted death rate for the cause: 20.2 deaths per 100,000 people
  • State total number of deaths per year for the cause: 1,618
  • State percentage of total deaths for the cause: 2.36%
Washington Olympia state capitol

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#48 – Washington

  • Most over-indexed cause of death: Pneumonitis due to solids and liquids
  • State age-adjusted death rate for the cause: 8.4 deaths per 100,000 people
  • State total number of deaths per year for the cause: 574
  • State percentage of total deaths for the cause: 1.01%
West virginia capitol

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#49 – West Virginia

  • Most over-indexed cause of death: Accidents (unintentional injuries)
  • State age-adjusted death rate for the cause: 102 deaths per 100,000 people
  • State total number of deaths per year for the cause: 1,892
  • State percentage of total deaths for the cause: 8.13%
Wisconsin Madison capitol

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#50 – Wisconsin

  • Most over-indexed cause of death: Accidents (unintentional injuries)
  • State age-adjusted death rate for the cause: 62.7 deaths per 100,000 people
  • State total number of deaths per year for the cause: 3,746
  • State percentage of total deaths for the cause: 7.11%
Cheyenne Wyoming Capital City Downtown Capitol Building Legislative Center

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#51 – Wyoming

  • Most over-indexed cause of death: Intentional self-harm (suicide)
  • State age-adjusted death rate for the cause: 27.6 deaths per 100,000 people
  • State total number of deaths per year for the cause: 157
  • State percentage of total deaths for the cause: 3.29%

Methodology

The underlying cause of death data is from the U.S. Centers for Disease Control and Prevention WONDER Online Database. The age-adjusted death rates shown are for 2017, using the 2017 population as the age-adjustment baseline. For the purpose of this analysis, only the top 15 leading causes of death nationally were considered.

For each state, the most over-indexed cause of death was determined by comparing the state level age-adjusted death rate for each cause to its respective national level age-adjusted rate. The cause of death that had the largest percent difference from the national rate was reported as the most over-indexed cause of death—representing a disproportionately high death rate within the state relative to the national rate.

Median household income statistics are from the U.S. Census Bureau Current Population Survey, Annual Social and Economic Supplements.

Complete Study Results

RankStateMost Surprising Cause of DeathDeath RateAnnual Deaths by CausePercentage of All Deaths
1AlabamaSepticemia20.81,0361.95%
2AlaskaIntentional self-harm (suicide)27.52004.53%
3ArizonaIntentional self-harm (suicide)19.11,3272.30%
4ArkansasChronic lower respiratory diseases80.62,5177.72%
5CaliforniaEssential hypertension and hypertensive renal disease15.45,5962.09%
6ColoradoIntentional self-harm (suicide)211,1813.10%
7ConnecticutPneumonitis due to solids and liquids9.23921.25%
8DelawareNephritis, nephrotic syndrome and nephrosis19.52052.23%
9District of ColumbiaAccidents (unintentional injuries)70.24278.60%
10FloridaAccidents (unintentional injuries)58.413,0596.41%
11GeorgiaSepticemia18.11,6111.94%
12HawaiiInfluenza and pneumonia35.86375.59%
13IdahoIntentional self-harm (suicide)23.73922.80%
14IllinoisNephritis, nephrotic syndrome and nephrosis202,5652.34%
15IndianaSepticemia19.41,2771.95%
16IowaChronic lower respiratory diseases55.71,9396.35%
17KansasIntentional self-harm (suicide)19.45532.04%
18KentuckySepticemia229792.03%
19LouisianaSepticemia24.41,0802.36%
20MaineIntentional self-harm (suicide)19.52741.87%
21MarylandSepticemia14.98821.77%
22MassachusettsPneumonitis due to solids and liquids7.75810.99%
23MichiganDiseases of heart236.525,18725.81%
24MinnesotaIntentional self-harm (suicide)14.27831.76%
25MississippiEssential hypertension and hypertensive renal disease19.25511.71%
26MissouriNephritis, nephrotic syndrome and nephrosis23.51,5152.45%
27MontanaIntentional self-harm (suicide)29.73113.05%
28NebraskaChronic lower respiratory diseases62.91,2247.25%
29NevadaIntentional self-harm (suicide)21.26272.54%
30New HampshireIntentional self-harm (suicide)19.22652.12%
31New JerseySepticemia201,8982.54%
32New MexicoChronic liver disease and cirrhosis29.36053.24%
33New YorkInfluenza and pneumonia21.14,5172.91%
34North CarolinaNephritis, nephrotic syndrome and nephrosis20.32,0402.19%
35North DakotaPneumonitis due to solids and liquids10.4861.34%
36OhioAccidents (unintentional injuries)76.58,9717.26%
37OklahomaChronic lower respiratory diseases79.43,0357.50%
38OregonIntentional self-harm (suicide)19.68252.25%
39PennsylvaniaAccidents (unintentional injuries)71.69,5277.02%
40Rhode IslandAccidents (unintentional injuries)63.37187.07%
41South CarolinaSepticemia17.28841.79%
42South DakotaIntentional self-harm (suicide)22.61912.39%
43TennesseeInfluenza and pneumonia25.21,6562.36%
44TexasSepticemia18.84,2682.15%
45UtahIntentional self-harm (suicide)236633.68%
46VermontIntentional self-harm (suicide)181121.86%
47VirginiaNephritis, nephrotic syndrome and nephrosis20.21,6182.36%
48WashingtonPneumonitis due to solids and liquids8.45741.01%
49West VirginiaAccidents (unintentional injuries)1021,8928.13%
50WisconsinAccidents (unintentional injuries)62.73,7467.11%
51WyomingIntentional self-harm (suicide)27.61573.29%

*The death rate is age-adjusted and for every 100,000 state residents.