The Least Healthy City in Every State

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26. Montana: Great Falls
> Premature death rate (per 100,000): 389.6 (state: 346.6)
> Adult obesity rate: 26.5% (state: 25.4%)
> Adult smoking rate: 18.4% (state: 18.5%)
> Median household income: $47,713 (state: $53,386)

Of the three metro areas in Montana, Great Falls is the least healthy. Adults in Great Falls are the least likely to exercise and most likely to smoke of any metro area in the state.

Uninsured adults are less likely to receive preventative medical care than adults with health insurance, and they are more likely to suffer negative health consequences such as preventable hospitalization as a result. In Great Falls, 10.2% of adults under age 65 lack health insurance, the largest uninsured rate in Montana. Additionally, there are 3,688 preventable hospitalizations per 100,000 Medicare enrollees in Great Falls, the highest rate of any metro area in the state.

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27. Nebraska: Omaha-Council Bluffs
> Premature death rate (per 100,000): 321.8 (state: 307.4)
> Adult obesity rate: 31.0% (state: 31.2%)
> Adult smoking rate: 16.4% (state: 17.0%)
> Median household income: $65,619 (state: $59,970)

Smoking is the leading cause of preventable death in the United States. Though the smoking rate of 16.4% in Omaha-Council Bluffs is below the rate of 17.0% amongst adults across the state, it is higher than the smoking rate in the two other metro areas in Nebraska — Grand Island and Lincoln. The premature death rate in Omaha of 322 deaths before age 75 for every 100,000 people is also higher than the statewide rate of 307 deaths per 100,000 Nebraska residents.

Lower-income households cannot afford as many healthy options related to health care, diet, and lifestyle as wealthy households, and as a result they often report worse health outcomes. In Omaha, 5.3% of households live on less than $10,000 a year, the largest share of any Nebraska metro area and slightly higher than the statewide share of 5.2%.

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28. Nevada: Carson City
> Premature death rate (per 100,000): 513.5 (state: 364.4)
> Adult obesity rate: 27.5% (state: 26.5%)
> Adult smoking rate: 17.7% (state: 16.5%)
> Median household income: $55,700 (state: $58,003)

Carson City has far and away the highest premature death rate of any metro area in Nevada. There are 514 deaths before age 75 for every 100,000 people in the metro area annually, more than double the state premature death rate of 364 per 100,000.

Smoking is the leading cause of preventable death in the United States. In Carson City, 17.7% of adults smoke, higher than the 16.5% state smoking rate. Obesity is also a risk factor for a number of potentially deadly diseases and conditions, including stroke, diabetes, and certain cancers, and Carson City’s 27.5% obesity rate is the highest of the three metro areas in Nevada.

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29. New Hampshire: Manchester-Nashua
> Premature death rate (per 100,000): 315.4 (state: 307.6)
> Adult obesity rate: 28.2% (state: 28.0%)
> Adult smoking rate: 15.2% (state: 18.0%)
> Median household income: $78,769 (state: $73,381)

Manchester is the only metro area in New Hampshire and therefore ranks as the least healthy city by default. Still, Manchester is slightly worse off than the state as a whole in a number of health outcomes. For example, Manchester’s premature death rate of 315 deaths before age 75 per 100,000 people is above the comparable state rate of 308 per 100,000.

Despite the poorer health outcomes, Manchester residents are more likely to exhibit certain healthy habits than the typical New Hampshire resident. Just 15.2% of metro area adults smoke, and 19.7% drink excessively, compared to 18.0% and 20.1% of adults statewide, respectively.

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30. New Jersey: Vineland-Bridgeton
> Premature death rate (per 100,000): 452.3 (state: 288.1)
> Adult obesity rate: 35.1% (state: 26.2%)
> Adult smoking rate: 17.2% (state: 14.0%)
> Median household income: $52,627 (state: $80,088)

In Vineland-Bridgeton, 23.2% of adults report being in fair or poor health, by far the largest share of any of the state’s four metro areas and well above the 16.5% share of adults who report similar health outcomes across New Jersey as a whole.

Poor health status among area adults may be partially attributable to unhealthy lifestyles. Just 69.8% of adults in the Vineland metro exercise regularly, the largest share in New Jersey. Adults in Vineland are also more likely to smoke and be obese than than the average adult in the state.