Findings Health Outcomes | 2023 Annual Report

Executive Brief Introduction National HighlightsFindingsHealth Outcomes Social and Economic Factors Physical Environment Clinical Care State Rankings International ComparisonAppendixMeasures Table Data Source Descriptions MethodologyState Summaries
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Rates of chronic conditions, premature death, drug deaths and frequent mental distress all continued to rise, reaching historically high levels.
Physical Health
The rates of eight chronic conditions reached their highest levels since America’s Health Rankings began tracking them, with striking disparities across nearly all subpopulations.
Multiple Chronic Conditions
Chronic conditions are medical conditions that last more than a year, require ongoing medical attention and/or limit daily life activities. Adults with multiple chronic conditions represent one of the highest-need populations for the U.S. health care system.
In 2022, 11.2% of U.S. adults, more than 29.3 million, had three or more of the following chronic health conditions: arthritis, asthma, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), cardiovascular diseases (CVDs), cancer (excluding non-melanoma skin), depression and diabetes.
Changes over time. All eight chronic conditions reached their highest values in America’s Health Rankings history in 2022. This peaking reversed such prior successes as multiyear improvements in arthritis, COPD and CVDs. Current prevalences either returned to or exceeded pre-pandemic levels. Nationally, between 2021 and 2022, arthritis increased 7% (25.8% to 27.7%), affecting nearly 70.0 million adults; asthma increased 6% (9.8% to 10.4%), affecting nearly 26.0 million adults; CVDs increased 14% (8.0% to 9.1%), affecting 24.2 million adults; CKD increased 17% (3.0% to 3.5%), affecting 9.7 million adults; COPD increased 10% (6.2% to 6.8%), affecting 17.8 million adults; depression increased 6% (20.5% to 21.7%), affecting nearly 54.2 million adults; and diabetes increased 6% (10.9% to 11.5%), affecting nearly 31.9 million adults. In 2022, 8.3% of adults (nearly 21.4 million) reported they had any form of cancer other than non-melanoma skin cancer.
Disparities. In 2022, the prevalence of multiple chronic conditions significantly varied by disability status, age, race/ethnicity, income, geography, educational attainment, veteran status, gender and metropolitan status.
Disability status. The prevalence of multiple chronic conditions was 9.7 times higher among adults with self-care difficulty (46.5%) than those without a disability (4.8%). Adults without a disability had the lowest prevalence of all eight chronic conditions.
The largest disparity by disability status was among adults with COPD. The prevalence was 7.7 times higher among adults with self-care difficulty (26.3%) than those without a disability (3.4%).
Adults with self-care difficulty also had high prevalences of arthritis (64.3%), CVDs (31.6%), diabetes (30.8%), asthma (23.4%), cancer (16.2%) and CKD (13.7%). Depression, however, was highest among those with cognitive difficulty (57.9%).

Race/Ethnicity. The prevalence of multiple chronic conditions was 5.2 times higher among American Indian/Alaska Native (17.8%) than Asian (3.4%) adults. Multiracial adults (15.6%) also had a higher prevalence. Asian adults had the lowest prevalence of all eight chronic conditions.
The largest disparity by race/ethnicity was among adults with COPD. The prevalence was 7.1 times higher among American Indian/Alaska Native (10.6%) than Asian (1.5%) adults.
Besides COPD, American Indian/Alaska Native adults had the highest prevalences of CVDs (14.6%), CKD (5.1%) and diabetes (17.9%). Diabetes prevalence was also high among Black (15.9%) and Hawaiian/Pacific Islander (15.0%) adults. The prevalence among American Indian/Alaska Native adults was also high for arthritis (30.9%), asthma (13.1%) and cancer (9.3%).
White adults had the highest prevalences of cancer (10.8%), 3.9 times higher than Asian adults (2.8%), and arthritis (31.2%).
Multiracial adults had the highest prevalence of asthma (15.8%). The prevalence was also high for depression (31.0%), arthritis (29.3%) and COPD (9.5%).

Income. The prevalence of multiple chronic conditions was 3.7 times higher among adults ages 25 and older with an annual household income less than $25,000 (24.4%) than those with incomes of $75,000 or more (6.6%). Adults with the highest household income level ($75,000 or more) had the lowest prevalence of all eight conditions.
The largest disparity by income level was among adults with COPD. The prevalence of COPD was 4.4 times higher among adults with a household income less than $25,000 (15.5%) than those with incomes of $75,000 or more (3.5%).
Adults with the lowest income level (less than $25,000) had the highest prevalence of all the chronic conditions except for cancer, which was highest among those with a household income of $50,000-$74,999 (10.0%), those with incomes of $25,000-$49,999 (9.9%) and those with incomes less than $25,000 (9.8%).

Geography. The prevalence of multiple chronic conditions was 3.0 times higher in West Virginia (21.1%) than Hawaii and the District of Columbia (both 7.0%).
West Virginia had the highest prevalences of diabetes (17.4%), 2.1 times higher than in Colorado (8.1%); CVDs (14.6%), 2.2 times higher than in Utah (6.6%); and arthritis (40.1%), COPD (14.0%) and cancer (10.8%).
Asthma was highest in Rhode Island (13.3%), and depression was highest in Tennessee (29.2%).
Hawaii had the lowest prevalence of cancer (6.6%) — but the District of Columbia had the lowest value, at 6.2% — COPD (3.5%) and depression (12.5%).
Arthritis was lowest in California (20.4%) and the District of Columbia (18.0%), asthma was lowest in Texas (7.9%), CVDs were lowest in Utah (6.6%) and the District of Columbia (6.3%), CKD was lowest in Alaska (2.4%), and diabetes was lowest in Colorado (8.1%) and the District of Columbia (8.0%).
Educational attainment. The prevalence of multiple chronic conditions was 2.6 times higher among adults ages 25 and older with less than a high school education (19.1%) compared with college graduates (7.4%). College graduates had the lowest prevalence of all conditions except cancer.
The largest disparity by educational attainment was among adults with COPD. COPD was 3.7 times higher among adults with less than a high school education (12.5%) than college graduates (3.4%).
This less-than-high-school vs. college-graduate disparity existed for asthma (11.3% vs. 8.4%), CVDs (15.9% vs. 6.7%), CKD (6.2% vs. 2.9%) and diabetes (21.7% vs. 9.0%).
Adults with less than a high school education (7.7%) had the lowest prevalence of cancer, and those with some post-high school education (10.0%) and high school graduates (8.9%) had the highest prevalence of cancer.
Arthritis was highest among those with a high school degree or GED (33.1%), those with less than a high school education (32.8%) and those with some post-high school education (33.0%).
Adults with some post-high school education (23.0%) and those with less than a high school education (21.7%) had the highest prevalence of depression.

Veteran status. The prevalence of multiple chronic conditions was 1.6 times higher among those who have served (16.6%) compared with those who have not served (10.5%) in the U.S. armed forces. Those who have served in the U.S. armed forces had higher prevalences across all conditions except asthma (10.3% vs. 6.8%) and depression (20.9% vs. 19.7%), which were higher among adults who have not served than those who have served.
The largest disparity by veteran status was among adults with CVDs. The prevalence was 2.1 times higher among adults who have served (17.6%) than those who have not served (8.3%).
Cancer was 1.8 times higher among adults who have served (13.5%) than those who have not served (7.6%).

Gender. The prevalence of multiple chronic conditions was higher among women (13.1%) than men (9.0%). Women had higher prevalences of all the conditions except for CVDs and diabetes, which were higher among men.
The largest disparity by gender was among adults with asthma. Asthma was 1.9 times higher among women (12.8%) than men (6.9%). 

Metropolitan status. The prevalence of multiple chronic conditions was higher among those living in a non-metropolitan (14.9%) than a metropolitan (10.4%) area. Adults living in non-metropolitan areas had a higher prevalence of all eight conditions than those living in metropolitan areas. 
The largest disparity by metropolitan status was among adults with COPD. The prevalence of COPD was 1.5 times higher among adults living in non-metropolitan (9.6%) than metropolitan (6.3%) areas.

Sexual orientation. The prevalence of multiple chronic conditions was similar between LGBQ+ (11.1%) and straight (11.5%) adults. However, straight adults had higher prevalences of the individual conditions, except asthma and depression.
The largest disparity by sexual orientation was among adults with depression. Depression was 2.4 times higher among LGBQ+ (45.4%) than straight (19.2%) adults.
Cancer was 1.7 times higher among straight (8.7%) than LGBQ+ (5.0%) adults.
Asthma was 1.6 times higher among LGBQ+ (15.2%) than straight (9.7%) adults.

Age. Age is a non-modifiable risk factor for many chronic conditions. The prevalence of multiple chronic conditions was 6.6 times higher among adults ages 65 and older (23.2%) than those ages 18-44 (3.5%).
The largest disparity by age group was among adults with cancer. Cancer was 11.2 times higher among adults ages 65 and older (20.1%) than those ages 18-44 (1.8%).
Besides cancer, the prevalences of arthritis (53.4%), CVDs (22.4%), CKD (8.3%), COPD (13.1%) and diabetes (23.9%) were highest among adults ages 65 and older and lowest among those ages 18-44.
However, for asthma (9.2%) and depression (15.5%), the oldest age group (65 and older) had the lowest prevalences. For asthma, the prevalence among the oldest age group was similar to those ages 18-44 (9.8%), and adults ages 45-64 (10.6%) had the highest prevalence. Adults ages 18-44 (23.7%) had the highest prevalence of depression.
Mortality
Premature Death
Unintentional injury, cancer, heart disease, COVID-19, suicide, homicide, liver disease, diabetes, perinatal period and chronic lower respiratory disease were, in order, the leading causes of years of potential life lost before age 75 in 2020. While accidents, including drug overdose, COVID-19, suicide and homicide, contributed to the current increase in premature death, chronic conditions accounted for six of the top 10 causes of mortality among those younger than 75 in 2020.
Changes over time. Nationally, premature death significantly increased 9% from 8,659 to 9,478 years lost before age 75 per 100,000 population between 2020 and 2021, the highest rate since 1987. This is the second straight year that there has been a stark increase in premature deaths. In 2021, the premature death rate significantly increased in 39 states, led by 21% in Alaska (9,409 to 11,430 years lost before age 75 per 100,000 population) and 17% in Idaho (7,145 to 8,365), New Mexico (11,896 to 13,946) and Oklahoma (10,873 to 12,764). During this time, the rate significantly decreased 10% in New Jersey (7,759 to 7,013) and 8% in New York (7,651 to 7,008).​
Disparities. The premature death rate was 2.4 times higher in Mississippi (15,250 years lost before age 75 per 100,000 population) than Massachusetts (6,454) in 2021.

Behavioral Health
Drug Deaths
Deaths resulting from drug overdoses place an enormous burden on individuals, families, communities, the health care system and the economy. Drug overdoses are a leading cause of injury death and have soared in recent years.
Changes over time. Nationally, deaths due to drug injury (unintentional, suicide, homicide or undetermined) significantly increased 15% from 27.9 to 32.1 deaths per 100,000 population between 2020 and 2021 — exceeding the Healthy People 2030 target of 20.7 deaths per 100,000. In 2021, nearly 106,700 people died from a drug overdose, an increase of 14,900 deaths since 2020. Since 2018, the rate has increased 56%, from 20.6 deaths per 100,000 population. Between 2020 and 2021, the drug death rate significantly increased in 29 states, led by 62% in Alaska (21.5 to 34.9 deaths per 100,000 population), 46% in Oregon (18.6 to 27.1) and 38% in Kansas (17.4 to 24.0). The rate significantly increased among most racial/ethnic and age groups, and all gender groups. By group, the largest increases were 35% among American Indian/Alaska Native populations (40.7 to 55.0), 27% among adults ages 65-74 (13.2 to 16.8) and 15% among both females (16.9 to 19.5) and males (38.9 to 44.9).​
Disparities. In 2021, the drug death rate significantly varied by race/ethnicity, geography, age and gender. The rate was:
12.0 times higher among American Indian/Alaska Native than Asian populations (4.6 deaths per 100,000 population).
7.7 times higher in West Virginia (87.1) than Nebraska (11.3).
3.7 times higher among adults ages 35-44 (62.0) than those ages 65-74.​*
2.3 times higher among males than females.
Frequent Mental Distress
A healthy mental state is essential to overall positive health and well-being. Frequent mental distress — defined as the percentage of adults who reported their mental health was not good 14 or more days in the past 30 days — is associated with smoking, physical inactivity, housing insecurity, food insecurity and insufficient sleep.
Changes over time. Nationally, the prevalence of frequent mental distress increased 8% from 14.7% to 15.9% of adults between 2021 and 2022, a continued trend since 2020. In 2022, nearly 40.7 million adults experienced frequent mental distress, an increase of almost 6.6 million adults since 2020. Between 2021 and 2022, the prevalence of frequent mental distress significantly increased 20% in Minnesota (12.3% to 14.8%), 18% in New York (13.0% to 15.4%) and 12% in Ohio (16.3% to 18.3%). During this time, the prevalence significantly increased among some income, educational attainment and age groups, and all gender and metropolitan status groups. By group, the largest increases were 19% among adults with an annual household income of $50,000-$74,999 (12.2% to 14.5%), 15% among adults with less than a high school education (16.6% to 19.1%), 11% among adults ages 65 and older (8.5% to 9.4%), 8% among men (12.0% to 13.0%) and adults living in both metropolitan (14.6% to 15.7%) and non-metropolitan (15.2% to 16.4%) areas.​
Disparities. In 2022, frequent mental distress significantly varied by disability status, sexual orientation, income, race/ethnicity, age, geography, educational attainment, gender and veteran status. The prevalence was:
5.2 times higher among adults with cognitive difficulty (49.2%) than those without a disability (9.4%).
2.5 times higher among LGBQ+ (34.2%) than straight (13.9%) adults, and among adults with an annual household income less than $25,000 (25.0%) than those with incomes of $75,000 or more (9.9%).​
2.3 times higher among multiracial (24.4%) than Asian (10.5%) adults.**
2.1 times higher among adults ages 18-44 (20.1%) than those ages 65 and older.​
1.8 times higher in West Virginia (21.1%) than Hawaii (11.5%), and among adults with less than a high school education than college graduates (10.5%).
Higher among women (18.3%) than men, and among adults who have not served (15.9%) than those who have served (14.4%) in the U.S. armed forces.


* The estimates for those ages 65-74 and those ages 15-24 (17.2) were not significantly different from each other based on non-overlapping 95% confidence intervals.
** The estimates for adults who identify their race as multiracial, American Indian/Alaska Native (22.2%) and Hawaiian/Pacific Islander (20.1%) were not significantly different from each other based on non-overlapping 95% confidence intervals.