Erectile dysfunction rarely arrives alone — it travels with obesity, diabetes, smoking, and physical inactivity, four of the best-documented modifiable risk factors in the NIH’s clinical literature. We combined the latest CDC state data on all four into a single index. This ranks risk-factor prevalence — not ED itself — and the geography is striking.
West Virginia ranks worst in the nation on three of the four measures — obesity (41.4%), diabetes (18.4%), and smoking (20.8%) — and #48 of 49 on inactivity.
Colorado posts the nation’s lowest obesity (25.0%), lowest diabetes (8.4%), and lowest inactivity (15.6%) — a 90-point index gap versus West Virginia.
West Virginia, Mississippi, Kentucky, Arkansas, Louisiana, and Alabama hold the six highest risk-factor burdens in the country.
Adult smoking ranges from 5.7% in Utah to 20.8% in West Virginia — the widest relative gap of any measure in the index.
Diabetes, obesity, smoking, and a sedentary lifestyle are consistently identified as modifiable risk factors for erectile dysfunction in the clinical literature, including the NIH’s reference on ED. Each is tracked annually, state by state, in the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) — the largest continuously running health survey in the world. That makes them the four most defensible, most comparable state-level signals of ED risk burden available.
One more reason this matters for men in midlife: CDC data show adults aged 45–54 have the highest obesity prevalence of any age group in America — 39.2% — and adults 40–59 are roughly 30% more likely to have obesity than adults under 40. The risk factors in this index concentrate in exactly the years when ED incidence climbs. And not all ED is physical — our guide to psychological ED covers the other half of the picture.
Index = equal-weighted average of the four measures, each normalized 0–100 across states (min–max). Higher = greater risk-factor burden. Sorted worst to best.
| # | State | Risk Factor Index | Obesity | Diabetes | Smoking | Physical Inactivity |
|---|---|---|---|---|---|---|
| 1 | West Virginia | 96.8 | 41.4% | 18.4% | 20.8% | 28.7% |
| 2 | Mississippi | 78.9 | 40.4% | 15.2% | 13.8% | 30.6% |
| 3 | Kentucky | 77.8 | 37.2% | 16.2% | 17.2% | 28.0% |
| 4 | Arkansas | 77.8 | 38.9% | 15.3% | 16.5% | 28.5% |
| 5 | Louisiana | 74.5 | 39.2% | 15.4% | 15.0% | 27.6% |
| 6 | Alabama | 71.7 | 38.9% | 15.1% | 14.0% | 27.6% |
| 7 | Oklahoma | 64.1 | 36.8% | 13.2% | 14.1% | 27.7% |
| 8 | Indiana | 63.8 | 38.4% | 14.3% | 13.9% | 24.6% |
| 9 | Ohio | 54.8 | 36.9% | 13.1% | 14.1% | 22.2% |
| 10 | Kansas | 54.0 | 37.6% | 12.5% | 13.7% | 22.4% |
| 11 | Michigan | 53.3 | 36.1% | 13.6% | 13.4% | 22.0% |
| 12 | Delaware | 53.0 | 36.6% | 13.2% | 10.1% | 25.2% |
| 13 | Texas | 51.9 | 35.6% | 13.5% | 10.0% | 25.1% |
| 14 | Missouri | 51.5 | 34.6% | 11.2% | 14.7% | 24.6% |
| 15 | Nevada | 50.0 | 34.2% | 13.6% | 11.9% | 23.2% |
| 16 | South Carolina | 50.0 | 34.6% | 13.9% | 12.6% | 21.7% |
| 17 | South Dakota | 49.4 | 37.0% | 11.8% | 13.5% | 21.4% |
| 18 | Georgia | 48.3 | 35.4% | 12.8% | 11.2% | 23.0% |
| 19 | Wisconsin | 48.1 | 37.4% | 11.9% | 11.9% | 21.7% |
| 20 | Pennsylvania | 48.0 | 34.2% | 13.3% | 11.7% | 22.7% |
| 21 | Iowa | 47.4 | 36.6% | 11.4% | 12.9% | 21.8% |
| 22 | Illinois | 45.8 | 34.2% | 12.8% | 10.5% | 23.3% |
| 23 | Nebraska | 45.2 | 37.6% | 10.5% | 12.2% | 21.6% |
| 24 | New Mexico | 44.8 | 34.5% | 12.3% | 12.0% | 21.7% |
| 25 | North Dakota | 44.6 | 36.8% | 10.6% | 12.3% | 21.7% |
| 26 | Maine | 44.3 | 33.2% | 11.5% | 14.4% | 21.4% |
| 27 | North Carolina | 43.8 | 34.5% | 13.2% | 11.5% | 20.2% |
| 28 | Virginia | 41.8 | 32.3% | 12.9% | 11.1% | 21.9% |
| 29 | Florida | 39.5 | 29.6% | 11.9% | 10.6% | 25.0% |
| 30 | Arizona | 38.0 | 33.3% | 11.5% | 10.1% | 21.8% |
| 31 | New York | 37.6 | 29.5% | 12.3% | 9.9% | 24.0% |
| 32 | Rhode Island | 36.4 | 31.1% | 11.6% | 9.9% | 22.9% |
| 33 | Wyoming | 36.3 | 32.5% | 10.1% | 12.7% | 21.0% |
| 34 | Oregon | 35.7 | 33.5% | 12.0% | 10.6% | 19.0% |
| 35 | Alaska | 35.3 | 34.0% | 9.4% | 14.7% | 18.1% |
| 36 | Connecticut | 33.1 | 32.0% | 11.7% | 9.0% | 20.8% |
| 37 | Maryland | 31.7 | 32.7% | 12.4% | 7.8% | 19.5% |
| 38 | Idaho | 28.9 | 32.7% | 9.3% | 9.6% | 20.7% |
| 39 | California | 28.4 | 29.1% | 12.6% | 7.6% | 20.7% |
| 40 | New Jersey | 26.9 | 27.7% | 10.8% | 8.6% | 22.8% |
| 41 | Montana | 26.5 | 31.0% | 8.7% | 12.2% | 19.1% |
| 42 | Minnesota | 26.0 | 32.3% | 10.1% | 10.2% | 17.5% |
| 43 | Hawaii | 24.3 | 27.0% | 11.5% | 8.1% | 21.3% |
| 44 | New Hampshire | 24.2 | 31.1% | 10.1% | 9.1% | 18.6% |
| 45 | Washington | 20.6 | 31.5% | 10.0% | 7.9% | 17.4% |
| 46 | Massachusetts | 16.5 | 27.0% | 9.6% | 8.8% | 18.8% |
| 47 | Vermont | 16.0 | 29.0% | 8.9% | 10.5% | 16.0% |
| 48 | Utah | 11.9 | 31.0% | 8.7% | 5.7% | 16.8% |
| 49 | Colorado | 6.6 | 25.0% | 8.4% | 9.7% | 15.6% |
| — | District of Columbia* | — | 25.5% | 8.4% | 8.5% | 13.9% |
| — | United States | — | 34.2% | 12.0% | 11.6% | 21.8% |
*DC is reported for reference but not ranked among states. Tennessee is excluded: its 2024 BRFSS data are missing in the source files for all four measures.
Data: adult prevalence of obesity (BMI ≥30), diagnosed diabetes, current smoking, and physical inactivity, from the CDC Behavioral Risk Factor Surveillance System, 2024 survey year, as published in America’s Health Rankings (United Health Foundation); accessed July 2026. Each measure was normalized across the 49 reporting states to a 0–100 scale using min–max scaling, then averaged with equal weights to form the index. The index describes the population-level prevalence of established ED risk factors by state; it does not measure the prevalence of erectile dysfunction itself, and no individual-level inference should be drawn from it.
Wondering where you stand personally? Risk factors are population math — your situation is individual. Our free, private 2-minute ED self-check uses the same questionnaire clinicians use, and Maro’s licensed clinicians treat ED online in most states.