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National In the past year, the age-adjusted number of deaths due to drug injury increased 7 percent from 14.0 to 15.0 deaths per 100,000 population. This increase continues an upward trend, with drug death rates up 23 percent since 2012 and up 60 percent since 2007 (Figure 14).

The drug death rate among males is 18.7 deaths per 100,000, which is significantly higher than females at 11.3 deaths per 100,000 population (Figure 15). Since 2012, the rate of drug deaths increased more among males (15.0 deaths in 2012 to 18.7 deaths in 2017 per 100,000) than among females (9.3 in 2012 to 11.3 in 2017). The rate of drug deaths among whites continues to be significantly higher than the rate for blacks, Hispanics, Asian/Pacific Islanders and American Indian/Alaska Natives.
State In the past year, drug deaths increased significantly in 14 states. In the last five years, the drug death rate increased significantly in 34 states and the District of Columbia. Notably, it declined significantly in Florida (Figure 16). Since 2012, Massachusetts, Rhode Island, Ohio, New Hampshire and West Virginia experienced the largest increases in the drug death rate.

National In the past five years, the percentage of adults with a body mass index of 30.0 or higher based on reported height and weight increased 8 percent from 27.8 percent to 29.9 percent of adults, with no significant change in the past year.
Obesity prevalence is similar for males and females, but it is significantly higher among blacks compared with whites, Hispanics and all other race/ethnicity groups except American Indian/Alaska Natives (Figure 17). Since 2012, obesity prevalence among adults increased more among American Indian/Alaska Natives (35.4 percent to 38.1 percent), Hawaiian/Pacific Islanders (25.0 percent to 30.6 percent), Hispanics (30.1 percent to 33.1 percent) and whites (26.2 percent to 28.6 percent) than among Asians (8.7 percent to 9.8 percent) and blacks (37.3 percent to 38.3 percent).
Obesity among adults aged 25 and older increased in all income groups in the past five years and is significantly higher among those living in households with less than $25,000 income versus all other household income levels (Figure 18). Obesity prevalence is also significantly higher among adults aged 25 and older without a high school degree than among those with all other educational levels and among rural adults versus suburban or urban adults.
State In Kansas, obesity prevalence decreased significantly in the past year from 34.2 percent to 31.2 percent of adults. In the past five years, obesity prevalence increased the most in North Dakota, Illinois, Arkansas, West Virginia and Tennessee (Figure 19). It declined slightly in Virginia and the District of Columbia.

National In the past five years, the incidence the sexually transmitted infection chlamydia increased 13 percent from 423.6 to 478.8 cases per 100,000 population (Figure 20). In the past eight years, the rate of chlamydia infections increased 30 percent from 367.5 to 478.8 cases per 100,000 population.
Chlamydia incidence among males is rising faster than among females, although the incidence is still less than half that of females (305.2 male cases versus 645.5 female cases per 100,000 population).

National Violent crime the number of murders, rapes, robberies and aggravated assaults per 100,000 population has increased 8 percent in the past two years, from 368 to 397 offenses per 100,000 population (Figure 21). Despite this increase, violent crime is 48 percent lower today than in 1993 when there were 758 offenses per 100,000 population.
State From 2015 to 2017, the largest increases in the number of offenses occurred in Alaska (640 to 804 offenses per 100,000 population) and Montana (253 to 368 offenses per 100,000 population). The largest decrease was in New Jersey (289 to 245 offenses per 100,000 population).

National The percentage of infants weighing less than 2,500 grams, or 5 pounds 8 ounces, at birth has remained historically high since 2007, hovering between 8.0 percent and 8.2 percent of live births (Figure 22). Black mothers have a significantly higher prevalence of low birthweight babies compared with white and Hispanic mothers. Overall, the prevalence of low birthweight decreases with educational attainment.
State In the past five years, the prevalence of low birthweight decreased in 24 states, with Mississippi, Oklahoma and New York experiencing statistically significant decreases.

National In the past year, the percentage of adults who reported being told by a health professional that they have diabetes (excluding prediabetes and gestational diabetes) increased 6 percent from 9.9 percent to 10.5 percent of adults (Figure 23). This is a new high. Since 2012, the prevalence of diabetes increased 11 percent from 9.5 to 10.5 percent of adults. Among adults aged 25 and older, diabetes prevalence is higher among those in the lowest education and income groups.
State In the past five years, diabetes prevalence significantly increased in seven states, with the largest increases in Kentucky, Alabama and West Virginia (Figure 24). Diabetes prevalence declined in the District of Columbia, South Dakota, Idaho, Alaska, Colorado and Kansas.

Challenges in Mortality Outcomes

National The age-adjusted number of deaths due to all cancer causes per 100,000 population has remained relatively constant at approximately 190 deaths per 100,000 population for the last eight years (Figure 25). Cancer deaths occur at a significantly higher rate among males than females, despite a decline in the cancer death rate among males in the past five years. Cancer death rates among females remained constant in the past five years.
The rate of cancer deaths among blacks at 218.1 deaths per 100,000 population is significantly higher than for whites at 190.6 deaths per 100,000 population. In the past five years, the cancer death rate among blacks has decreased from 224.2 deaths per 100,000 to 218.1, while whites have experienced an increase from 189.7 deaths to 190.6. Blacks have a higher rate of cancer deaths than Hispanics, Asian/Pacific Islanders and American Indian/Alaska Natives.
State In the past five years, the rate of cancer deaths significantly increased in nine states, with the largest increases in West Virginia and Utah (Figure 26). The cancer death rate significantly decreased in five states ― Massachusetts, Connecticut, Washington, California and New Jersey. Wyoming and Delaware also experienced large decreases.

National Cardiovascular deaths ― the age-adjusted number of deaths due to all causes of cardiovascular disease including heart disease and stroke per 100,000 population ― increased for the second consecutive year after continuously decreasing for the first 25 years of America’s Health Rankings history (Figure 27). In the past two years, the cardiovascular death rate increased significantly by 2 percent, from 250.8 to 254.6 deaths per 100,000 population.
Males have a significantly higher cardiovascular death rate than females. The rate of cardiovascular deaths among blacks is significantly higher than whites, Hispanics, Asian/Pacific Islanders and American Indian/Alaska Natives. In the past five years, cardiovascular deaths declined among Asian/Pacific Islanders, Hispanics and blacks. Cardiovascular deaths have held approximately constant among whites.
State In the past two years, the rate of cardiovascular deaths significantly increased in 21 states and significantly decreased only in California. In the past five years, Nevada and Utah experienced the largest increases in the cardiovascular death rate, while New York and West Virginia experienced the largest decreases (Figure 28).

National There was no improvement in the infant mortality rate in the past year (Figure 29). In the past 10 years, the infant mortality rate, defined as the number of infant deaths occurring before age 1 per 1,000 live births, decreased 13 percent from 6.8 to 5.9 deaths per 1,000 live births. For an international context, see Comparison With Organization for Economic Cooperation and Development Countries.
State The infant mortality rate declined in the past five years by more than 1.0 death per 1,000 live births in Rhode Island, Colorado, Virginia, Pennsylvania, Tennessee and Mississippi (Figure 30). Conversely, over the same time period, the infant mortality rate increased by more than 1.0 death per 1,000 live births in Maine and Alaska, the states with the largest increases in the past five years.

National Premature death includes deaths from all causes before the age of 75 and is an important indicator of a population’s health. In the past two years, the premature death rate the number of years of potential life lost before age 75 per 100,000 population significantly increased 3 percent from 6,997 to 7,214 years lost per 100,000 population (Figure 31). This is the third straight year premature death increased, however, it still remains dramatically lower than in 1990 when the rate was 8,716 years lost per 100,000 population (Figure 32).

State In the past year, the premature death rate increased in 47 states, with statistically significant increases in 18 states. Premature death varies from fewer than 6,000 years of potential life lost before age 75 per 100,000 population in Minnesota, California, New York, Connecticut, New Jersey and Massachusetts to more than 10,000 in Louisiana, Kentucky, Alabama and Mississippi. Premature death is highly correlated with the overall state ranking (r2=0.91).
From 2012 to 2017, the largest increases in the premature death rate occurred in New Mexico, Alaska, Vermont, South Dakota and New Hampshire; each state increased by more than 500 years of potential life lost per 100,000 population (Figure 33). Over the same time, the largest decreases in premature death occurred in the District of Columbia, Hawaii and California; each state decreased by at least 500 years lost per 100,000 population.

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