Best and Worst States for Lung Cancer Patients

X-ray showing lung cancer

Lung cancer is the deadliest cancer in America — and the pandemic has only made things worse. 

Every year, lung cancer kills more people in the U.S. than colon, breast and prostate cancers combined — but the combined effects of coronavirus and lung cancer can be disastrous. 

Recent research confirms that lung cancer greatly enhances the severity of COVID-19, increasing the death rate to as high as 25%, which is many times the rate of COVID-related deaths in the general population. 

To help raise awareness of this deadly disease, LawnStarter compared the 50 states and the District of Columbia across 32 key indicators of lung cancer risk, prevalence, prevention strength, treatment accessibility and treatment affordability. 

Table of Contents

  1. Surprising Findings
  2. State Rankings
  3. Key Takeaways
  4. Methodology
  5. Why This Study Matters

Surprising findings

  • States in the Deep South didn’t fare well in our ranking. Many Southern states have higher levels of tobacco use and lower treatment affordability, which may have contributed to very high 5-year death rates in states like Arkansas and Mississippi.

    What this means: Smoking — and thus potentially lung cancer — could be a persistent problem in this region for some time to come.
  • High uninsured rates is one common factor that connects many of the lowest-ranked states. In each of the 10 bottom states, at least 10% of the population is without coverage. Worst off is Texas, with 18.4% of the state’s population having no insurance.

    Why are insurance numbers so low in these states? Eight of those 10 states — including Texas — have opted out of Medicaid expansion. 

See how each state fared in our ranking:

Best and Worst States for Lung Cancer Patients

RankStateOverall ScoreRisk RankPrevalence RankPrevention RankTreatment Access RankTreatment Affordability Rank
2New York66.19231422
6District of Columbia59.0344128111
8New Hampshire56.83114115107
12Rhode Island53.83534112828
27New Jersey49.55332118738
30New Mexico47.45284275041
31North Carolina46.503928261630
34North Dakota44.684714232437
42South Dakota39.914035354432
45South Carolina37.863233493129
47West Virginia36.265151382117
Infographic showing best and worst states by various categories, such as number of oncologists, percentage of smokers, etc.

Key Takeaways

The Tobacco Belt

Most U.S. tobacco has been grown in the Tobacco Belt states of Kentucky, North Carolina, Tennessee and Virginia, but these are not the worst-off states when it comes to lung cancer. In the final ranking, these states finished mid-range.

On the minus side: These states all have high 5-year death rates, few smoking restrictions and some of the lowest cigarette taxes in the nation.

On the plus side: Tobacco Belt states bucked their history in part due to higher Medicaid spending and more access to medical care, such as specialists and surgeries.

Bigger Is Better

Some of the top states in our lung cancer study also contain the largest U.S. cities. Why?

Tougher on smoking: States like California and Massachusetts tend to have more anti-smoking laws and higher cigarette taxes, and these states also have the lowest cigarette use among adults.

Better health care: These urbanized states have easy access to specialists and large medical centers, large percentages of Medicaid spending, and the lowest uninsured rates in the nation.

Utah Stands Tall

The Beehive State is a unique outlier in our ranking. It takes the top spot in both the lowest lung cancer risk and prevalence categories. Possible reasons why:

— Fewest smokers: Utah has the lowest rates of tobacco use across all age groups, which may explain why it also has the fewest estimated lung cancer-related deaths than any other state.

Mormon influence? Why is this the case despite low numbers in treatment access and affordability? The answer may lie in the Mormon Church’s ban on smoking tobacco. Apparently, church can be good for both spiritual and respiratory health.


To determine the Best and Worst States for Lung Cancer Patients, LawnStarter first surveyed existing research on the disease.

In our review, we found that no single report combines all publicly available lung cancer data to provide a comprehensive overview of each state’s performance in key indicators. The objective of this study was therefore to provide the first such report of its kind.

To measure each state’s performance, we identified and collected the most recently available data for 32 indicators of lung cancer risk, prevalence, prevention strength, treatment access and treatment affordability. 

Next, we assigned a weight to each metric based on its significance within its indicator category and applied a weight-based score. Each single weight is equal to roughly 1.52 points, which we calculated by dividing a total possible score of 100 points by the total number of weights, 66.

Finally, we compared the 50 U.S. states and the District of Columbia by summing up their scores across the 32 indicators. The state that scored the highest was ranked No. 1, or “best,” while the state with the lowest score was ranked No. 51, or “worst.”

1. Risk

  • Cigarette Use Among Youth (Triple-Weighted)
    Note: Tobacco smoke is the leading cause of lung cancer in the U.S., according to the EPA.
  • Toxic Chemicals Release (Double-Weighted)
    Note: This metric specifically measures the ratio of toxic-chemicals released to the state’s surface area. “Toxic chemicals” include those that are known to cause cancer and/or respiratory issues, according to the U.S. Environmental Protection Agency.
  • Risk-Screening Environmental Indicator Score (Double-Weighted)
    Note: “A RSEI risk score is an estimate of potential risk to human health [of toxic substances from industrial facilities]. It is a unitless value that accounts for the magnitude of the release quantity of a chemical, the fate and transport of the chemical throughout the environment, the size and locations of potentially exposed populations, and the chemical’s inherent toxicity,” according to the EPA. 
  • E-cigarette Use Among Adults (Single-Weighted)
    Note: “The aerosol from an e-cigarette can contain nicotine and other substances that are addictive and can cause lung disease, heart disease, and cancer,” according to the American Cancer Society.
  • E-cigarette Use Among Youths (Single-Weighted)
    Note: “The aerosol from an e-cigarette can contain nicotine and other substances that are addictive and can cause lung disease, heart disease, and cancer,” according to the American Cancer Society.
  • Average Age of Vehicles (Single-Weighted)
    Note: This metric was used as a proxy for toxic emissions output, for which no state-level data is publicly available. Generally, the newer the vehicle, the more efficient it is, and the fewer its greenhouse gas emissions, according to the EPA.

2. Prevalence

  • Estimated New Cases per 100,00 Population (Triple-Weighted)
  • Estimated Deaths per 100,000 Population (Triple-Weighted)
  • Latest Death Rate (Double-Weighted)
  • 5-Year Death Rate (Double-Weighted)
  • 5-Year Survival Rate (Double-Weighted)

3. Prevention

  • High-Risk Screening Rate (Triple-Weighted)
  • Smoke-Free Air Laws (Double-Weighted)
    Note: Smoke-free indoor air laws include those for bars, restaurants, and worksites.
  • Vehicle Smoking Restrictions (Double-Weighted)
  • Cigarette Tax (Double-Weighted)
    Note: This metric specifically measures various ranges of excise taxes on cigarettes.
  • E-Cigarette Tax Laws (Double-Weighted)
    Note: This binary metric measures the presence or absence of such laws in the state.
  • Tobacco Cessation and Treatments Available (Double-Weighted)
    Note: Tobacco cessation programs and treatments include those that the state covers to help smokers quit.
  • Use of Quitline Service per 1,000 Tobacco Users (Single-Weighted)
    Note: This metric measures the number of callers to the Quitline service who received counseling or medications.
  • Tailpipe Emission Standards (Single-Weighted)
    Note: This binary metric measures the presence or absence of such standards in the state.

4. Treatment Access

  • Number Cancer Centers (Triple-Weighted)
    Note: Cancer centers include those that are designated by the National Cancer Institute (NCI) as providers of “cutting-edge cancer treatments.”
  • Oncologists per 100,000 Population (Triple-Weighted)
  • Radiation Therapists per 100,000 Population (Double-Weighted)
  • Respiratory Therapists per 100,000 Population (Double-Weighted)
  • Share of Patients Treated with Surgery (Double-Weighted)
  • Share of Patients Receiving No Treatment (Single-Weighted)

5. Treatment Affordability

  • Uninsured Rate (Triple-Weighted)
  • Medicaid Coverage of Screening (Triple-Weighted)
  • Adoption of Medicaid Expansion (Double-Weighted)
  • Medicaid Spending Out of Total State Budget (Single-Weighted)

Sources: Alliance of Automobile Manufacturers, American Cancer Society, American Council for an Energy-Efficient Economy, American Lung Association, American Society of Clinical Oncology, Bureau of Labor Statistics, Centers for Disease Control and Prevention (CDC), Kaiser Family Foundation, National Cancer Institute, Public Health Law Center at Mitchell Hamline School of Law,, U.S. Census Bureau and U.S. Environmental Protection Agency

Why This Study Matters

Americans are more at risk for lung cancer and have fewer treatment options depending on the state where they reside. Reducing lung cancer saves lives and money. Lifetime health care costs of lung cancer currently stand at $282,000. 

The coronavirus pandemic has only intensified the challenges for lung cancer patients, who face a much higher chance of death if they contract COVID-19. Medical care facilities already overburdened with COVID-19 cases may be strapped to care for lung cancer patients.

The lung cancer picture isn’t all dark. Researchers are making sweeping progress in the care and treatment of lung cancer patients.  
There is hope: Lung cancer deaths have steadily decreased since the mid-1990s, attributed by researchers to falling tobacco use. New treatments involving genetics and immunotherapy have also contributed to the decline.

Main Photo Credit: Shutterstock


Staff Writer