West Virginia is the unhealthiest state in America, according to a study released by Forbes Advisor Tuesday morning. 

In addition to West Virginia, the top five unhealthiest states included Mississippi, Kentucky, Alabama and Arkansas. Notably, nine of the 10 least healthy states are located in the South, according to the study. 

Conversely, Hawaii was named the healthiest state in America, followed by Utah, Minnesota, California and Massachusetts. The study found that five of the 10 healthiest states are located in the Pacific and West, though the western half of the country was also home to five of the 10 worst states for substance abuse. 

The report, based on an analysis of data collected from the Centers for Disease Control and Prevention as well as the Kaiser Family Foundation, ranked the states on more than 20 metrics across three categories: disease prevalence and mortality rate, substance abuse as well as lifestyle habits and health outlook. 

According to the CDC, six in 10 Americans suffer from at least one chronic disease and four in 10 adults have two or more chronic diseases.

West Virginia led the way with the highest prevalence of illness and death from chronic diseases while also holding the second-lowest life expectancy. The Mountain State also has the highest cancer incidence rate in the nation as well as the highest heart disease, diabetes and kidney disease mortality rates. 

Meanwhile, Hawaii had the longest lifespan, the second-lowest percentage of obese adults and the sixth-lowest percentage of adults who smoke. The Aloha State also reported the lowest number of alcohol-induced deaths and recorded the seventh-lowest score in the substance abuse category.

The Forbes Advisor report is another deep dive into the regional differences affecting the health of Americans. 

In November, a study found that California was the healthiest state based on an analysis of key health indicators like gyms per capita, percentage of adult smokers and obesity rates.  

In August, WalletHub released a report that found Rhode Island has the best healthcare system in the U.S., while Mississippi has the worst.

In June, U.S. News unveiled its annual Healthiest Communities rankings in collaboration with CVS Health, with Los Alamos County, New Mexico taking home the top honor.