By William Thornton

The “Heart of Dixie” might need a bypass.

That’s according to a new survey from Forbes Advisor, which ranked the states according to overall health, chronic disease, substance abuse and other factors. Alabama ranked as the sixth unhealthiest state in the U.S., finding a slot among its other Deep South neighbors.

As the U.S. continues to see escalating levels of high blood pressure, obesity and diabetes, about six in 10 American adults have at least one chronic disease and four in 10 have two or more, according to the Centers for Disease Control and Prevention (CDC).

To arrive at the ranking, Forbes Advisor compared all 50 states across 21 metrics, including disease risk factors and prevalence, substance abuse and lifestyle habits.

Hawaii, with its sunny climate, inviting beaches and high living standard, is the survey’s healthiest state. Besides its residents boasting the longest average lifespan (at just under 81 years), Hawaii has among the lowest rates of diabetes, cancer mortality, liver disease, heart disease, obesity and illicit drug use.

But the secret to health isn’t just found on Diamond Head Beach. Hawaii is followed by Utah, Connecticut, Minnesota and Massachusetts.

On the opposite end, eight of the top 10 states can be found in the South. The unhealthiest state, according to the survey, is West Virginia. It has the highest rates of diabetes, high cholesterol, and had the highest drug overdose death rate – at 75.03 per 100,000 state residents – more than 50% higher than the second-worst state, Delaware.

It’s followed by Mississippi, Tennessee, Arkansas and Kentucky.

Coming in sixth is Alabama, which had the lowest score among the bottom 10 for substance abuse. About 13% of Alabamians have diabetes, while about 235 out of every 100,000 in the state die of heart disease, according to the survey.

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