The Least Healthy City in Every State

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41. South Dakota: Rapid City
> Premature death rate (per 100,000): 315.7 (state: 339.7)
> Adult obesity rate: 26.8% (state: 31.1%)
> Adult smoking rate: 15.5% (state: 18.1%)
> Median household income: $56,318 (state: $56,521)

Of the two metro areas in South Dakota — Sioux Falls and Rapid City — Rapid City is the least healthy. Unlike in Sioux Falls, adults in Rapid City report more than three physically unhealthy days and more than three mentally unhealthy days per month on average.

Some 12.6% of adults in Rapid City report being in fair or poor health, more than the 10.0% of adults who report similar health outcomes in Sioux Falls and the 11.8% of adults in fair or poor health statewide. For every 100,000 Rapid City residents, 316 die before the age of 75 — more than the Sioux Falls premature death rate of 302 per 100,000, yet less than the state rate of 340 per 100,000.

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42. Tennessee: Memphis
> Premature death rate (per 100,000): 468.2 (state: 445.6)
> Adult obesity rate: 35.1% (state: 33.0%)
> Adult smoking rate: 20.3% (state: 22.1%)
> Median household income: $50,984 (state: $51,340)

Low birthweight can be indicative of unhealthy maternal lifestyles, limited access to health care, and other negative environmental factors. In Memphis, 11.2% of newborns weigh less than what is considered a healthy weight, compared to 9.1% of newborns across the state as a whole.

Living below the poverty line can greatly reduce an individual’s ability to make healthy lifestyle choices, and as a result, poorer Americans often report worse health outcomes. In Memphis, 17.1% of residents live below the poverty line, compared to 15.0% of the Tennessee population.

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43. Texas: Texarkana
> Premature death rate (per 100,000): 499.7 (state: 339.5)
> Adult obesity rate: 37.4% (state: 29.0%)
> Adult smoking rate: 19.3% (state: 14.3%)
> Median household income: $47,722 (state: $59,206)

In Texarkana, Texas, 37.4% of adults are obese, well above the state obesity rate of 29.0%. Obesity is a risk factor for a number of potentially deadly diseases and conditions, including diabetes, heart disease, and certain cancers, and premature death is far more common in Texarkana than it is across the state as a whole. For every 100,000 people in the metro area, there are 500 deaths before age 75 annually, compared to 339 per 100,000 across Texas.

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44. Utah: Salt Lake City
> Premature death rate (per 100,000): 308.9 (state: 291.5)
> Adult obesity rate: 25.3% (state: 25.9%)
> Adult smoking rate: 9.5% (state: 8.8%)
> Median household income: $71,510 (state: $68,358)

Of Utah’s five metro areas, Salt Lake City is the least healthy. Part of the reason may be environmental. The air in Salt Lake City has the highest concentration of harmful particulate matter of any of any other metro area in the state. Still, Salt Lake City’s air is cleaner than average on a national scale.

Adults in Salt Lake City are also more likely than those in every other metro area in the state to have certain unhealthy habits. For example, 16.0% of adults in the city drink excessively and 9.5% smoke, higher than the excessive drinking rate of 13.4% and the smoking rate of 8.8% statewide.

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45. Vermont: Burlington-South Burlington
> Premature death rate (per 100,000): 283.6 (state: 300.0)
> Adult obesity rate: 22.6% (state: 25.5%)
> Adult smoking rate: 13.0% (state: 17.0%)
> Median household income: $63,160 (state: $57,513)

Burlington is the only metro area in Vermont, and as a result, it ranks as the least healthy city in the state by default only. In fact, in several measures, city residents are more likely to have healthier lifestyles and report better health outcomes than those living across the state as a whole. For example, just 13.0% of adults in Burlington smoke, compared to 17.0% of the adult population in Vermont as a whole. Adults in Burlington are also more likely to regularly exercise and are less likely to be obese than the typical adult in the state.

Healthy behaviors can lead to healthy outcomes, and in Burlington, adult residents report an average of just 3.6 mentally unhealthy days per month, compared to an average of about four days per month across the state.