Here are the U.S. states where women face the highest mortality rates

We tend to hear the same advice for living long and healthy lives over and over again: Eat well, exercise, don’t smoke. But you know what we don’t often hear? “Hey, you might consider moving to North Dakota.” That’s because most people don’t realize that the state in which we live can, in fact, significantly impact our life expectancy—a reality brought to life by a fascinating new study.

For the study, social scientists at Syracuse University and University of Wyoming analyzed mortality rates for women in all 50 states. Their goal was to determine if differences in these rates across state lines occurred because of women’s individual characteristics or because of the environment in which they lived. In other words: Is it the state of Tennessee’s fault that women are more likely to die there compared to other states, or do women who live in Tennessee happen to be predisposed to earlier deaths? Or both? These are important questions to ask because they ultimately get at whether a given state’s public policies help to extend women’s lives—or cut them short.

For their analysis, the researchers relied on data from the U.S. National Longitudinal Mortality Study, which is essentially a state-by-state death survey collected by the federal government. The survey data was conducted during the 1980s and 1990s, with mortality follow-ups through 2002.

When analyzing the data, the researchers first took into account individual characteristics that contribute to mortality, including age, race, education, poverty, and marital status. Next, they looked into state features that contribute to mortality, including the state’s economic environment (e.g., median household income), social cohesion (e.g., the connection and support people feel from their community), sociopolitical orientation (e.g., tax structures, public expenditures), physical infrastructure (e.g., resources for housing and transportation), and the tobacco environment (i.e. strict or lax tobacco laws).

All five of these state features have been shown to affect residents’ mortality. For example, take physical infrastructure—a state’s housing infrastructure can indirectly affect mortality if rental costs make up a large portion of household income, leaving less money for other needs. Similarly, sociopolitical orientation can determine how state money is allocated to programs benefiting education, welfare, health, and hospitals, which can also in turn affect mortality.

After analyzing the data, the authors found that 30% of the variation in women’s mortality across states was accounted for by individual characteristics. However, 53% of the variation in women’s mortality was accounted for by state features. Ultimately, on the whole, the environment in which the women lived had a greater impact on them than their individual characteristics.

“The results provide compelling evidence that inequalities in women’s mortality cannot be reduced to women’s personal choices and characteristics; instead, the influence of socioeconomic and political contexts must be considered,” write the authors.

So how did the states stack up? As the map above reveals, the five states with the lowest mortality rates were: Hawaii (#1), South Dakota (#2), North Dakota (#3), Nebraska (#4), and Montana (#5), colored in yellow. The states with the highest mortality rates were: Nevada (#50), West Virginia (#49), Tennessee (#48), Wyoming (#47), and Virginia (#46), colored in dark red. “The disparity is substantial,” write the authors. “The probability of death in Nevada is 1.7 times greater than Hawaii.”

When they dove even deeper into the data, the authors discovered that two state features stood out as especially critical: economic environment and social cohesion. And this makes sense. Past research has shown that poor economic environment, including high unemployment rates or significant income inequality, can take a toll on women’s health, especially if they’re raising children on their own. As for social cohesion, other studies have pointed out that our health is improved by having strong support networks and feelings of social trust social trust.

Notably, the authors replicated the same study on men but didn’t find the same state effects. “Consistent with our expectation, the state-level mortality variation was less strongly associated with the contextual features among men than among women,” write the authors.

While individual factors accounted for 34% of state variation in men’s mortality (versus 30% for women), only 23% of the variation in men’s mortality was accounted for by the state features (versus 53% in women). States are having a much more significant impact on women’s mortality than men’s.

“[These findings] make sense given that many state policies are inherently more relevant for women,” explain the authors in the study. “For example, state policies that shape access to health care, prenatal care, affordable housing, children’s health care, subsidized school lunches, family leave, and financial safety nets are especially important for women given that they are more likely than men to be socioeconomically disadvantaged, raising children, caring for aging parents, interfacing with the health care system, and employed in unstable and low-paying jobs.”

Indeed, women’s life expectancy in the U.S. has stagnated since the 1980s, in part due to obesity and smoking, but more broadly due to a complex cocktail of factors. As Lisa Berkman, director of the Harvard Center for Population and Development Studies, explained to The New York Times earlier this year, public policy has not caught up to the demands of women who have entered the workforce. Today, women hold down full-time jobs—but are still expected to be the primary caretakers of children and are more likely to provide help for aging parents. All of this results in a “second-shift” of household work for women, which men are much less likely to face. As a result, public polices (or the lack thereof) such as maternity leave and paid sick days are affecting women’s lives at a greater rate.

“Divergent social and economic policies across states have played an important role in shaping the inequalities in women’s mortality,” conclude the authors.

The upshot? We need more people in government fighting for women—and I can think of one presidential candidate who is definitely up to the task.

Taryn Hillin is Fusion’s love and sex writer, with a large focus on the science of relationships. She also loves dogs, Bourbon barrel-aged beers and popcorn — not necessarily in that order.