Health risk factors in the U.S. statistics & facts

The risks that shape American health

Most deaths in the United States are not caused by accidents or infections but by chronic diseases such as heart disease, stroke, cancer and diabetes, and most of those diseases are driven by a small number of risk factors. High blood pressure, obesity, tobacco, alcohol, drugs, physical inactivity, poor diet and too little sleep account for a large share of illness, disability and early death. The good news is that these risks can be measured, tracked and changed, which is why federal health agencies monitor them closely through surveys such as the National Health and Nutrition Examination Survey, the National Health Interview Survey and the Behavioral Risk Factor Surveillance System.

The latest data paint a mixed picture. Nearly half of American adults have high blood pressure, four in ten have obesity, and 40 million people have diabetes. Yet cigarette smoking has fallen to a record low of 9.1 percent of adults, drug overdose deaths have fallen sharply since their 2023 peak, and the adult obesity rate appears to have started to decline as millions of Americans take GLP-1 weight-loss drugs. This report sets out the data on each major risk factor, how it has changed over time, who is most affected and how many deaths it is linked to.

How common are the major risk factors?

The chart compares the share of US adults affected by each major risk factor, using the most recent national survey for each. High blood pressure is the most widespread, affecting 47.7 percent of adults, followed by obesity at 40.3 percent. More than half of adults do not meet the federal guideline for aerobic physical activity, and almost a third regularly sleep less than seven hours a night.

Blood pressure leads: 47.7 percent of US adults have high blood pressure and 40.3 percent have obesity, the two most widespread risk factors.

Many of these risks cluster in the same people. Obesity raises the risk of high blood pressure, diabetes and high cholesterol, while smoking, heavy drinking and inactivity often go together. People with lower incomes and less education are more likely to have several risk factors at once, which helps explain why life expectancy in the United States varies so widely between groups and regions. The size and age structure of the population, set out in our data on the US population by sex and age, also matters: many risks rise sharply with age, and the population is getting older.

High blood pressure: the most common risk

High blood pressure, or hypertension, is the single most common serious risk factor in the United States. According to NHANES data for August 2021 to August 2023, 47.7 percent of adults had hypertension, defined as a blood pressure of 130/80 mm Hg or higher or taking medication to lower it. Prevalence was higher in men, at 50.8 percent, than in women, at 44.6 percent, and rose steeply with age: 23.4 percent of adults aged 18 to 39, 52.5 percent of those aged 40 to 59 and 71.6 percent of those aged 60 and over.

Only one in five controlled: just 20.7 percent of adults with high blood pressure had it under control, and more than four in ten did not know they had it.

The biggest problem is not diagnosis but control. Among adults with hypertension, only 59.2 percent were aware of it, 51.2 percent were taking medication, and just 20.7 percent had their blood pressure under control, with no significant improvement compared with the period before the COVID-19 pandemic. According to the CDC, high blood pressure was a primary or contributing cause of 680,179 deaths in 2024, and it cost the country an estimated 219 billion dollars a year in 2019. Global Burden of Disease estimates for 2023 attribute 47 percent of US deaths from ischemic heart disease to high systolic blood pressure, more than any other single risk.

Obesity: four in ten adults

Obesity is the risk factor that has changed most over the past six decades. In the early 1960s, 13.4 percent of American adults had obesity, defined as a body mass index of 30 or more. The share rose steadily from the 1980s onward, passed 30 percent around 2000, and reached 42.4 percent in 2017 to 2018. In the most recent NHANES data, for August 2021 to August 2023, it was 40.3 percent, a change that was not statistically significant. Severe obesity, a body mass index of 40 or more, has kept rising, reaching 9.7 percent on an age-adjusted basis.

Tripled in 60 years: adult obesity rose from 13.4 percent in 1960 to 1962 to 40.3 percent in 2021 to 2023, and severe obesity from 0.9 to 9.7 percent.

Obesity is most common in middle age, affecting 46.4 percent of adults aged 40 to 59, compared with 35.5 percent of those aged 20 to 39 and 38.9 percent of those aged 60 and over. Women are more likely than men to have severe obesity, at 12.1 percent against 6.7 percent. Education makes a large difference: 31.6 percent of adults with a bachelor degree or higher had obesity, compared with around 45 percent of those without a degree. Because NHANES measures height and weight directly rather than relying on what people report, it is considered the most accurate source of national obesity data.

Obesity by state

State data come from the Behavioral Risk Factor Surveillance System, which relies on self-reported height and weight and therefore produces lower figures than NHANES. In 2024, adult obesity was highest in West Virginia at 41.4 percent, Mississippi at 40.4 percent and Louisiana at 39.2 percent, and lowest in Colorado at 25.0 percent and the District of Columbia at 25.5 percent, according to an analysis of CDC data by TFAH, a public health nonprofit. Nineteen states had rates of 35 percent or more, down from 23 in 2023.

A 16-point gap: adult obesity ranged from 41.4 percent in West Virginia to 25.0 percent in Colorado in 2024.

The newest state maps, released by the CDC on 24 September 2026 and based on 2025 data, show that no state or territory had an adult obesity prevalence of 40 percent or more, while 21 states, Guam and Puerto Rico had a prevalence between 35 and 40 percent. The District of Columbia had the lowest figure, at 24.2 percent. By region, obesity was most common in the Midwest, at 35.5 percent, and the South, at 34.8 percent, and least common in the West, at 30.7 percent, and the Northeast, at 29.6 percent.

The GLP-1 effect

A new class of medicines may be starting to change the obesity picture. GLP-1 receptor agonists such as semaglutide, sold as Ozempic and Wegovy, and tirzepatide, sold as Mounjaro and Zepbound, were developed for type 2 diabetes but produce substantial weight loss. According to Gallup, the share of US adults taking a GLP-1 injection for weight loss more than doubled from 5.8 percent in early 2024 to 12.4 percent in mid-2025, and over the same period the obesity rate in its self-reported survey fell from a peak of 39.9 percent in 2022 to 37.0 percent in 2025.

Most common in middle age: 17.0 percent of adults aged 50 to 64 were taking a GLP-1 drug for weight loss in 2025, against 6.7 percent of those aged 18 to 29.

Use is higher among women, 15.2 percent, than men, 9.7 percent. The drugs remain expensive, supply was constrained for much of 2023 and 2024, and many people stop taking them, so their long-term effect on national obesity rates is still uncertain. Measured NHANES data covering the period of rapid uptake will be needed to confirm the trend. The rise of these medicines has also transformed the drug industry, as covered in our overview of the global pharmaceutical industry.

Diabetes and prediabetes

Diabetes is both a disease and a major risk factor for heart disease, stroke, kidney failure and blindness. The CDC estimates that 40.1 million Americans, or 12.0 percent of the population, had diabetes in 2023, of whom 29.1 million had been diagnosed and 11.0 million had not. More than a quarter of adults with diabetes, 27.6 percent, did not know they had it. A further 115.2 million adults had prediabetes, blood sugar levels that are higher than normal but not yet high enough to be diagnosed as diabetes, including more than half of those aged 65 and over.

Most cases are type 2 diabetes, which is closely linked to obesity and physical inactivity. Gallup self-reported data show diabetes reaching an all-time high of 13.8 percent of adults in 2025. Global Burden of Disease researchers found that high fasting blood sugar was one of the fastest-growing contributors to heart disease deaths in the United States between 1990 and 2023, rising by 39 percent as a share of the burden, second only to high body mass index.

Cholesterol: a quiet success

High cholesterol is one risk factor that has improved. The share of adults with high total cholesterol, 240 mg/dL or more, fell from 18.3 percent in 1999 to 2000 to 11.0 percent in 2013 to 2014, and was 11.3 percent in August 2021 to August 2023, helped by the widespread use of statin drugs. Low levels of HDL, the so-called good cholesterol, also became less common, falling from 22.2 percent of adults in 2007 to 2008 to 13.8 percent. Men were far more likely than women to have low HDL, at 21.5 against 6.6 percent. Even so, high LDL cholesterol remains a leading cause of heart disease, accounting for an estimated 29 percent of US ischemic heart disease deaths in 2023.

Smoking falls to a record low

Cigarette smoking is the great public health success story of the past 60 years. In 1965, 42.4 percent of American adults smoked cigarettes. After the first Surgeon General report on smoking and health in 1964, and decades of taxes, advertising restrictions, smoke-free laws and cessation programmes, the rate fell below 20 percent by 2010 and to 11.6 percent in 2022. Early release data from the 2025 National Health Interview Survey put it at a record low of 9.1 percent.

Down by almost four fifths: adult cigarette smoking fell from 42.4 percent in 1965 to 9.1 percent in 2025.

Smoking still causes enormous harm. The CDC estimates that cigarette smoking and secondhand smoke cause more than 480,000 deaths in the United States every year, including more than 40,000 among nonsmoking adults exposed to secondhand smoke, and that more than 16 million Americans live with a disease caused by smoking. Smoking remains the leading cause of preventable death. At the same time, 6.7 percent of adults used electronic cigarettes in 2025, most of them younger adults, and the long-term health effects of vaping are still being studied.

Alcohol: 178,000 deaths a year

Excessive alcohol use is one of the leading preventable causes of death. The CDC estimates that about 178,000 people died each year from excessive drinking in 2020 and 2021, a 29 percent increase from about 138,000 a year in 2016 and 2017. Two thirds of those deaths, about 117,000, resulted from long-term drinking, through cancers, heart disease, liver disease and alcohol use disorder, while one third, about 61,000, resulted from the effects of drinking too much on a single occasion, such as motor vehicle crashes, poisonings and suicides. On average, these deaths shortened lives by 24 years.

Binge drinking, defined as four or more drinks on one occasion for women or five or more for men, is the most common form of excessive drinking. In 2023, 16.4 percent of US adults reported binge or heavy drinking, the lowest rate in five years, according to an analysis of BRFSS data by the State Health Access Data Assistance Center. In January 2025 the US Surgeon General issued an advisory highlighting the link between alcohol and at least seven types of cancer.

Drug overdoses fall from their peak

Drug overdoses became one of the most visible health crises in modern American history. Deaths rose from about 70,600 in 2019 to a peak of about 108,000 in 2022, driven by illicit fentanyl, which increasingly contaminated the supply of heroin, cocaine, methamphetamine and counterfeit pills. Since then the trend has reversed. Final CDC data show overdose deaths fell 26.2 percent from 105,007 in 2023 to 79,384 in 2024, the largest annual decline on record, and provisional data point to about 69,100 deaths in the 12 months ending in January 2026.

A sharp reversal: overdose deaths fell from about 108,000 in 2022 to 79,384 in 2024 and about 69,100 in the 12 months to January 2026.

Deaths involving synthetic opioids other than methadone, mainly fentanyl, fell 35.6 percent between 2023 and 2024, from 72,776 to 47,735. Researchers point to several possible reasons, including wider access to the overdose-reversal drug naloxone, more treatment with medications for opioid use disorder such as buprenorphine and methadone, changes in the illicit drug supply, and changes in drug use patterns. The age-adjusted overdose death rate fell to 23.1 per 100,000 in 2024, close to its level in 2019, though still far above the rates of the early 2000s. Mental health and substance use are closely linked, as discussed in our report on mental health worldwide.

How many deaths are linked to each risk?

Comparing the number of deaths linked to each risk factor helps show where the burden is greatest, although the estimates use different methods and some deaths are counted under more than one risk. High blood pressure was listed as a primary or contributing cause on 680,179 death certificates in 2024. Smoking causes more than 480,000 deaths a year, excessive drinking about 178,000, and drug overdoses 79,384 in 2024.

Blood pressure and tobacco dominate: high blood pressure contributed to about 680,000 deaths in 2024, and smoking causes more than 480,000 a year.

Obesity, poor diet and physical inactivity are harder to count in this way, because they act mainly through other conditions such as heart disease, diabetes and cancer. Global Burden of Disease estimates for 2023 attribute 39 percent of US ischemic heart disease deaths to dietary risks, and found that high body mass index was the fastest-growing contributor to heart disease deaths since 1990, up 55 percent. Almost 89 percent of US ischemic heart disease deaths in 2023 were linked to modifiable risk factors.

Physical activity and sleep

Regular physical activity lowers the risk of heart disease, stroke, type 2 diabetes, several cancers and depression, yet most Americans do not get enough. In 2024, 47.2 percent of adults met the federal guideline of at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity a week, according to the National Health Interview Survey. Men were more likely to meet it than women, at 52.3 against 42.4 percent, and the share fell with age from 54.0 percent of those aged 18 to 34 to 38.4 percent of those aged 65 and over. Adults in rural areas, at 40.2 percent, were less active than those in large cities, at 51.5 percent, and only 22.4 percent of adults with a disability met the guideline.

Sleep is increasingly recognised as a health risk in its own right. In 2024, 30.5 percent of adults slept less than seven hours a night, the minimum recommended for adults, rising to 34.5 percent of those aged 50 to 64 and 40.2 percent of Black adults. Short sleep is linked to obesity, diabetes, high blood pressure, heart disease and depression, as well as accidents. New technologies, from wearable trackers to AI-based screening, are giving people and doctors more ways to monitor these risks, as covered in our data on the most exciting technologies for healthcare and AI in healthcare.

What comes next for American health

The data show that American health risks are moving in different directions. Smoking and overdose deaths are falling, cholesterol has improved, and obesity may finally be turning a corner. But high blood pressure remains poorly controlled, diabetes is at record levels, severe obesity continues to rise, and deaths from alcohol increased sharply around the pandemic. Many of these risks are closely tied to income, education and where people live.

Three developments will shape the next decade. The spread of GLP-1 drugs could reduce obesity, diabetes and heart disease if costs fall and access widens. Better control of blood pressure, which requires regular screening and consistent treatment, could prevent hundreds of thousands of heart attacks and strokes. And public health programmes on tobacco, alcohol and overdoses will need sustained funding to hold on to recent gains. The economic stakes are large: chronic diseases driven by these risks account for most of US health spending, a significant share of the national economy described in our data on US GDP, and a growing market for the companies covered in our reports on the medical technology industry and leading medical device companies.

US health risks in numbers

A few figures sum up the state of the major risks.

Together they show both how much progress is possible and how much remains to be done.

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