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Older adults in Louisiana face the highest stroke risk in the US, new data reveals. Six other Southern States make up the top 10 of our index, as levels of blood pressure, obesity, and diabetes all increase below the Mason-Dixon line.
Strokes remain one of the leading health risks facing older Americans, with over 70% of all strokes occurring after the age of 65.1 According to the CDC, nearly 800,000 people in the US have a stroke each year, with older adults disproportionately affected.2
To better understand the lifestyle differences and underlying health conditions that can impact stroke risk, we analyzed state-level data from America’s Health Ranking, exploring the prevalence of the following risk factors in over-65s:
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High blood pressure
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Obesity
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Physical inactivity
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Smoking
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Excessive drinking
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Diabetes
Our analysis found that Southern states featured prominently, with Louisiana, Tennessee, and West Virginia topping the ranking.
Beyond the immediate health impact, strokes can have a long-term effect on mobility, independence, and overall quality of life. For many seniors, convalescing after a stroke is about maintaining the ability to live comfortably and safely at home, rather than fully recovering.
Opera Beds is committed to helping people across America live comfortable, independent lives, regardless of where they live.
For families exploring ways to support aging at home, options such as home hospital beds can improve comfort, mobility, and caregiver support.
Key takeaways
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Louisiana ranks as the state with the highest stroke risk score and some of the highest rates of high blood pressure (72%) and diabetes (28%) among seniors
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Southern states dominate the top rankings, with Tennessee and West Virginia making up the top three highest-risk areas
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Utah has the lowest stroke risk score (0.93), with its low levels of smoking (5.1%) and excessive drinking (4.1%)
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High blood pressure is the most widespread risk factor, affecting over two-thirds (70%) of seniors in several high-risk states
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Lifestyle factors such as inactivity and obesity are consistently higher in top-ranking states, reinforcing the link between daily habits and stroke risk in later life
The US states where over-65s face the highest stroke risk
Stroke risk among older Americans is not evenly distributed, and a clear regional pattern emerges when looking at the data.
Across the US, the average stroke risk score is 4.9 out of 10, but in the highest-risk states, this figure rises sharply to above 8.0, highlighting a significant divide in health outcomes depending on where people live.
Interestingly, our top 10 is dominated by a cluster of southern states, with Louisiana, Tennessee, and West Virginia consistently reporting higher-than-average levels across multiple risk factors.
| Rank | State | High blood pressure prevalence (65+) | Obesity prevalence (65+) | Physical inactivity (65+) | Smoking prevalence (65+) | Excessive drinking prevalence (65+) | Diabetes prevalence (65+) | Stroke risk score /10 |
|---|---|---|---|---|---|---|---|---|
| 1 | Louisiana | 72.0% | 36.1% | 40.4% | 10.5% | 8.4% | 28.0% | 8.97 |
| 2 | Tennessee | 68.3% | 33.4% | 36.9% | 12.0% | - | - | 8.54 |
| 3 | West Virginia | 70.5% | 34.7% | 41.7% | 12.4% | 5.2% | 29.0% | 8.02 |
| 4 | Arkansas | 67.5% | 34.2% | 40.2% | 10.0% | 6.4% | 26.3% | 7.29 |
| 5 | Missouri | 63.4% | 32.8% | 37.7% | 10.8% | 9.0% | 22.4% | 7.28 |
| 6 | Alabama | 72.8% | 33.6% | 41.0% | 9.9% | 4.3% | 26.9% | 7.09 |
| 7 | Texas | 62.5% | 32.8% | 37.1% | 10.0% | 7.6% | 29.0% | 7.07 |
| 8 | Indiana | 65.8% | 35.3% | 32.2% | 11.0% | 6.2% | 27.0% | 7.02 |
| 9 | Mississippi | 72.2% | 32.2% | 42.2% | 9.3% | 5.1% | 28.6% | 6.84 |
| 9 | Ohio | 63.0% | 33.7% | 36.4% | 9.9% | 7.7% | 24.7% | 6.84 |
1. Louisiana, stroke risk score: 8.97 out of 10
Louisiana ranks as the state with the highest stroke risk among older adults, with some of the highest rates of key risk factors in the country, including high blood pressure (72.0%), physical inactivity (40.4%), and diabetes (28.0%) among adults aged 65+.
Dealing with multiple high-risk factors at once significantly increases the likelihood of a stroke and could compound the complexity of its long-term effects.
For older adults in Louisiana, this elevated risk highlights the importance of both prevention and access to effective recovery support to help maintain independence.
2. Tennessee, stroke risk score: 8.54 out of 10
Tennessee’s high-risk score is shaped more by behavioural factors than any single condition. The state reports the third-highest smoking rates (12.0%) and elevated levels of obesity (33.4%) and physical inactivity (36.9%), all of which are closely linked to increased stroke risk.
Although the risk of having a stroke increases in the over-65s, these everyday habits can increase the likelihood even further – emphasizing the importance of making healthier choices as we age.3
3. West Virginia, stroke risk score: 8.02 out of 10
Third in our ranking is West Virginia, with a score of 8.02, driven by consistently high levels across multiple risk factors.
The state’s over-65s are second in rankings of physical inactivity, diabetes, and smoking. Meanwhile, high blood pressure affects over two-thirds (70.5%) of the state’s population aged 65 and older.
The US states where over-65s face the lowest stroke risk
While stroke risk is elevated in several southern states, the opposite trend can be seen across parts of the West and Northeast, where older adults benefit from lower levels of key risk factors and, in many cases, healthier lifestyles.
States like Utah, Colorado, and Vermont stand in stark contrast to higher-risk southern states such as Louisiana and Mississippi. In these lower-risk states, rates of high blood pressure, inactivity, and smoking are consistently lower, in some cases by as much as 15% or 20%.
| Rank | State | High blood pressure prevalence (65+) | Obesity prevalence (65+) | Physical inactivity (65+) | Smoking prevalence (65+) | Excessive drinking prevalence (65+) | Diabetes prevalence (65+) | Stroke risk score /10 |
|---|---|---|---|---|---|---|---|---|
| 1 | Utah | 54.6% | 27.9% | 22.4% | 5.1% | 4.1% | 20.4% | 0.93 |
| 2 | Colorado | 52.1% | 23.8% | 23.0% | 6.4% | 7.7% | 17.9% | 1.16 |
| 3 | Vermont | 54.0% | 24.4% | 25.9% | 6.1% | 8.4% | 17.0% | 1.61 |
| 4 | Washington | 55.6% | 28.1% | 22.3% | 6.1% | 8.2% | 20.2% | 2.13 |
| 5 | Massachusetts | 57.1% | 26.1% | 30.4% | 6.8% | 7.7% | 18.1% | 2.27 |
| 6 | Hawaii | 54.9% | 20.5% | 28.4% | 7.0% | 9.3% | 19.2% | 2.43 |
| 7 | California | 56.8% | 23.4% | 26.8% | 7.0% | 7.6% | 24.9% | 2.63 |
| 8 | New Mexico | 57.7% | 27.5% | 31.1% | 7.7% | 6.3% | 20.5% | 2.84 |
| 9 | Idaho | 57.3% | 30.6% | 28.9% | 8.2% | 7.3% | 18.1% | 2.94 |
| 10 | Montana | 53.3% | 29.9% | 27.4% | 8.1% | 9.2% | 16.4% | 3.09 |
1. Utah, stroke risk score: 0.93 out of 10
Utah ranks as the lowest-risk state, consistently scoring below national averages. Physical inactivity, for example, sits at 22.4%, nearly 10% below the average (31.8%), and almost half the level seen in Mississippi (42.2%), one of the highest-risk states.
Smoking (5.1%) and excessive drinking (4.1%) are also significantly below the national averages (8.8% and 7.6%), and far lower than states like Tennessee and South Dakota, where smoking exceeds 12%.
2. Colorado, stroke risk score: 1.16 out of 10
Colorado follows closely, with high blood pressure affecting 52.1% of seniors, around 9 percentage points below the national average (61.1%), and dramatically lower than Alabama (72.8%), the highest-ranking state.
Physical inactivity (23.0%) is also well below average (31.8%), highlighting a clear contrast with high-risk states like West Virginia (41.7%). Diabetes prevalence is similarly lower at 17.9%, compared to nearly 29% in southern states like Texas and West Virginia.
3. Vermont, stroke risk score: 1.61 out of 10
Vermont completes the top three, with a consistently lower-risk profile. Obesity (24.4%) and smoking (6.1%) both sit well below national averages (30.7% and 8.8%), and significantly under levels seen in Louisiana, where obesity reaches 36.1%.
Diabetes prevalence is also notably lower at 17.0%, compared to 28–29% in high-risk states like Mississippi and West Virginia.
Interestingly, Vermont also topped our list of the best states for seniors – scoring 8.36 out of 10 in that ranking.
Read the full report here: Aging Well in the US: Best and Worst States for Seniors.
States with the highest blood pressure
High blood pressure is a significant contributor to stroke risk, particularly in later life. Often referred to as a silent condition, it can go unnoticed while placing ongoing strain on the heart and blood vessels.
| Rank | State | High blood pressure prevalence (65+) |
|---|---|---|
| 1 | Alabama | 72.8% |
| 2 | Mississippi | 72.2% |
| 3 | Louisiana | 72.0% |
In each of these states, more than 7 in 10 seniors have high blood pressure, sitting over 10% above the national average (61.1%). This widespread prevalence emphasizes the importance of early detection, regular monitoring, and lifestyle changes, such as limiting salt intake, staying active, and managing stress, to help lower risk.
This pattern is reflected in broader health outcomes, too: Mississippi has the lowest life expectancy in the country, at 71.9 years, suggesting that residents in the state may face more long-term health challenges than high blood pressure alone.4
States with the highest level of obese seniors
Obesity is closely linked to a range of conditions that increase the chances of a stroke, including high blood pressure, diabetes, and cardiovascular disease.
| Rank | State | Obesity prevalence (65+) |
|---|---|---|
| 1 | Louisiana | 36.1% |
| 2 | Illinois | 35.8% |
| 3 | Indiana | 35.3% |
With over a third of seniors affected in these states, obesity remains a key factor influencing long-term health outcomes. Maintaining a balanced diet and staying physically active can help reduce these risks and support overall well-being in later life.
In the top 3 states, obesity levels sit well above the national average (30.7%).
Compared to lower-risk states like Hawaii (20.5%), Colorado (23.8%), and California (23.4%), which all finished in the bottom 10 of our table, this gap widens to over 10% – reinforcing the impact of weight-related health conditions on the risk of having a stroke.
The states with the least active seniors
Regular physical activity is essential for maintaining cardiovascular health, mobility, and independence. A lack of movement can contribute to several stroke-related risk factors, including obesity and high blood pressure.
| Rank | State | Physical inactivity (65+) |
|---|---|---|
| 1 | Mississippi | 42.2% |
| 2 | West Virginia | 41.7% |
| 3 | Alabama | 41.0% |
In these southern states, more than 4 in 10 seniors report low levels of physical activity, well above the national average of 31.8%, and nearly 20% above states like Utah and Washington.
Although it can be difficult as we get older, gentle, consistent movement, such as walking, stretching, or light exercise, can make a meaningful difference in lowering stroke risk and supporting day-to-day independence.
The states with the highest levels of seniors who smoke
Smoking remains one of the most preventable causes of strokes, as it damages blood vessels and increases the likelihood of clot formation.
| Rank | State | Smoking prevalence (65+) |
|---|---|---|
| 1 | South Dakota | 14.1% |
| 2 | West Virginia | 12.4% |
| 3 | Tennessee | 12.0% |
Smoking rates are generally lower in older populations compared to younger groups. These figures show that a significant number of seniors are still exposed to its harmful effects, with the top 3 in this category being well above the national average of 8.8%.
By comparison, Utah (5.1%) and Vermont (6.1%) have significantly lower rates, highlighting a clear divide in lifestyle-related risk.
Quitting smoking at any age can lead to meaningful improvements in cardiovascular health and overall quality of life.
The states with the most seniors who drink excessively
Excessive alcohol consumption can increase blood pressure and contribute to a higher risk of strokes over time.
| Rank | State | Excessive drinking prevalence (65+) |
|---|---|---|
| 1 | Alaska | 11.1% |
| 2 | District of Columbia | 10.4% |
| 3 | Wisconsin | 9.6% |
While moderate alcohol consumption may be manageable for some, consistently high intake can place additional strain on the body. Alaska, Columbia, and Wisconsin all exceed the national average of 7.6%, with Alaska’s score nearly three times higher than bottom-placed Utah (4.1%).
Understanding safe limits and making gradual changes can help limit long-term health risks.
The states with the highest diabetes prevalence among seniors
Diabetes is a major contributor to stroke risk, as it can damage blood vessels and increase the likelihood of cardiovascular complications.
| Rank | State | Diabetes prevalence (65+) |
|---|---|---|
| 1 | Texas | 29.0% |
| 2 | West Virginia | 29.0% |
| 3 | Mississippi | 28.6% |
In these states, close to 3 in 10 seniors are living with diabetes – around 6% higher than the national average of 22.9% and over 10% lower than states like Vermont (17%) and Colorado (17.9%).
Effective management, such as monitoring blood sugar levels, maintaining a healthy diet, and staying active, is essential for reducing stroke risk and supporting long-term health.
On a national scale, over half of Americans above the age of 65 (31.3 million) are living with prediabetes. This is the term used when someone’s blood sugar levels are higher than normal, but not at a level where type 2 diabetes can be diagnosed.5
Methodology
Opera Beds has designed and supplied home-hospital beds that combine advanced clinical features with a homelike style for over 20 years. With a focus on improving comfort, mobility, and independence, we support individuals and caregivers with thoughtfully designed, high-quality solutions.
With stroke posing a serious health risk for older adults and often having a lasting impact on quality of life, we set out to better understand how risk and outcomes vary across the United States.
1. Stroke mortality
For stroke mortality among adults aged 65+ per 100,000 people, data was sourced from the CDC WONDER database.
2. Stroke risk factors
We analyzed the prevalence of the following risk factors among adults aged 65+:
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High blood pressure (2023)
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Obesity (2023)
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Physical inactivity (2023)
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Smoking (2023)
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Excessive drinking (2024)
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Diabetes (2024)
Data was sourced from America’s Health Rankings.
Each factor was normalized to a score out of 10, and an average score was calculated to produce an overall Stroke Risk Score for each state. This score reflects the relative prevalence of stroke-related risk factors, rather than actual stroke incidence. Where data was unavailable, scores were calculated using the remaining available factors.
All data was collected in March 2026 and is correct as of then.
