Premature Death Risk by State: Complete Rankings (2026)

West Virginia leads with 141 deaths per 100,000 working-age adults from unintentional injuries, nearly four times Nebraska's rate of 38 per 100,000. Unintentional injuries include motor vehicle crashes, falls, workplace accidents and other trauma.

Highest unintentional injury death rates (working-age adults ages 25 to 64, age-adjusted per 100,000):

• West Virginia: 140.8
• Delaware: 100.7
• New Mexico: 98.7
• Kentucky: 96.5
• Ohio: 91.4
• Tennessee: 90.6

Lowest rates:

• Nebraska: 38.0
• Maryland: 40.0
• Minnesota: 41.6
• Iowa: 41.7

Rural states with long driving distances, higher speed limits and dangerous occupations see high injury deaths. Less immediate access to trauma care also plays a role. Motor vehicle crash death rates run two to three times higher in rural Appalachian states than in urban Northeastern states.

West Virginia and New Mexico lead nationally in combined drug overdose and alcohol-induced deaths among working-age adults. Rates in West Virginia and New Mexico run nearly four times higher than the lowest-risk states.

Highest drug and alcohol death rates (working-age adults ages 25 to 64, age-adjusted per 100,000):

• West Virginia: 134.9
• New Mexico: 119.8
• Delaware: 98.1
• Washington, D.C.: 92.9
• Ohio: 88.2
• Kentucky: 88.1

Lowest rates:

• Texas: 33.8
• Nebraska: 38.7
• Georgia: 39.0
• Hawaii: 40.3

West Virginia's rate is nearly four times Texas' rate, representing 100 additional deaths per 100,000 working-age adults annually. Each overdose death often eliminates 30 to 40 years of potential life.

States with stronger addiction treatment infrastructure, better Medicaid coverage for substance use disorders and aggressive harm reduction programs see lower overdose rates.

Mississippi, Alabama and Arkansas see heart disease deaths among working-age adults at rates more than three times those in Minnesota and Oregon. Heart disease remains a leading killer during working years, with rates varying threefold across states.

Highest heart disease death rates (working-age adults ages 25 to 64, age-adjusted per 100,000):

• Mississippi: 120.1
• Alabama: 111.6
• Arkansas: 109.9
• Oklahoma: 107.1
• Louisiana: 103.4
• Kentucky: 101.2

Lowest rates:

• Minnesota: 36.9
• Oregon: 38.7
• Massachusetts: 39.8
• Utah: 40.9

Obesity rates and smoking rates vary considerably between high-risk and low-risk states. Access to preventive care, hypertension control and early intervention all vary. Heart disease deaths often strike in the 50s and early 60s, years when people are approaching retirement but still supporting families and carrying mortgages.

Wyoming, Montana and Alaska report suicide rates exceeding 31 per 100,000, more than triple rates in Washington, D.C., New Jersey and New York. Suicide rates among working-age adults peak in Mountain West states and Alaska.

Highest suicide rates (working-age adults ages 25 to 64, age-adjusted per 100,000):

• Wyoming: 36.7
• Montana: 32.2
• Alaska: 31.3
• New Mexico: 31.2
• Utah: 29.4
• Oklahoma: 28.2

Lowest rates:

• Washington, D.C.: 8.1
• New Jersey: 10.6
• New York: 11.1

Rural isolation, limited mental health care access, economic distress and cultural barriers to seeking help contribute to high suicide rates in Mountain West and rural states. Suicide affects men in their 40s and 50s disproportionately, often primary breadwinners whose deaths leave families financially vulnerable.

YPLL-75 per 100,000 (50% weight)

Years of Potential Life Lost before age 75 (YPLL-75) per 100,000 population measures how many years are cut short when people die before reaching age 75, age-adjusted. YPLL emphasizes deaths during working years and family formation, when mortality's financial and social impacts are most severe. A death at age 40 contributes 35 years of life lost. A death at age 70 contributes five years.

Working-age mortality rate, ages 25 to 64 (50% weight)

Death rate among adults ages 25 to 64 per 100,000 population, age-adjusted. Working-age mortality measures how often working-age adults die, capturing mortality during the years when most adults support families, carry mortgages and provide primary household income. The 25 to 64 age band represents the period of greatest financial vulnerability to early death.

Each state received two separate ranks based on YPLL-75 and working-age mortality. MoneyGeek calculated an average rank using equal weighting (50%) for both YPLL-75 rank and working-age mortality rank. States were then sorted by average rank to produce final rankings from one (lowest risk) to 51 (highest risk). Ties were broken by lower YPLL-75, then by lower working-age mortality.

States were assigned ratings based on final rank position:

• Lower Risk (ranks one to 18): Lowest premature death risk
• Moderate (ranks 19 to 38): Average risk
• High Risk (ranks 39 to 51): High premature death risk

Several additional variables appear in tables and narrative for explanatory context but don't contribute to state rankings: life expectancy at birth, adult smoking rates, adult obesity rates, uninsured rates and cause-specific mortality rates by state. Context variables help explain why certain states experience high premature mortality but weren't used to calculate rankings.

YPLL data use 2021 to 2023 averages, reflecting the most current premature mortality estimates available from SHADAC. Working-age mortality rates and cause-specific deaths use 2018 to 2020 averages from CDC WONDER, representing the most recent finalized vital statistics available at the state level at time of analysis. The difference in time periods doesn't affect state-to-state comparisons. Mortality rankings are stable over time. Multi-year averages smooth year-to-year volatility and provide more stable estimates than single-year snapshots.

MoneyGeek's analysis identifies premature mortality patterns across states but can't prove causation for individual outcomes. State-level averages mask variation within states by county, race, income and individual circumstances. Some high-mortality states still contain counties with relatively low premature death rates, and vice versa. Migration patterns, where healthier residents leave high-mortality states while less healthy residents remain, may contribute to observed differences.

Life insurance premium quotes require individual underwriting and vary by carrier, policy type, coverage amount, term length and applicant-specific health and demographic factors. MoneyGeek's analysis describes general geographic risk patterns but can't predict rates for individual applicants. Readers making insurance decisions should request personalized quotes from licensed insurers and consult insurance professionals for individual guidance.

Data reflect the most recent finalized estimates available as of January 2026 and may be revised by source agencies.