States with heavier chronic disease burdens tend to report somewhat lower rates of skipped checkups, according to a Becker’s analysis of three new KFF datasets. Chronic conditions typically require regular physician visits, which likely keeps patients connected to routine care.
However, 14 jurisdictions break that pattern: seven with high rates on both measures and seven with low rates on both.
Arkansas, Ohio, Wyoming, Oregon, Wisconsin, Montana and Oklahoma reported above-median rates of chronic disease among working-age adults in 2025 and above-median rates of adults skipping a routine checkup — a sign that preventive care may not be reaching people in states where need is high.
KFF’s datasets are all drawn from the CDC’s 2025 Behavioral Risk Factor Surveillance System, a state-based telephone survey of adults. The data covers 11 chronic conditions: heart disease, stroke, hypertension, diabetes, cancer, arthritis, asthma, chronic obstructive pulmonary disease, depression, kidney disease and severe obesity.
Nationally, 56.4% of adults ages 18 to 64 reported at least one chronic condition in 2025, and 13.6% reported three or more. Meanwhile, 20.6% of all adults 18 and older said they had not had a routine checkup in the past year.
Six things to know:
1. West Virginia reported the highest chronic disease burden. Sixty-nine percent of its working-age adults reported at least one chronic condition, and 23.8% reported three or more — about 1.75 times the national rate. And consistent with the broader pattern, 18% of West Virginia adults skipped a checkup, below the national rate.
2. Seventeen states, mostly in the South and Midwest, reported more chronic disease and fewer skipped checkups than the typical state, including Kentucky, Alabama, Louisiana and Michigan. Another 17, mostly in the West and Plains, showed the reverse: less chronic disease and more skipped checkups.
3. Among the seven states above the median on both measures, Arkansas had the highest chronic disease rate, at 63.3%, with 21.2% of adults skipping a checkup. In Wyoming, 31.2% of adults skipped a checkup in the past year — the highest rate in the nation and about 1.5 times the national rate.
4. At the other end, seven jurisdictions — largely in the Northeast corridor — reported below-median rates on both measures: New Jersey, New York, Massachusetts, Connecticut, Maryland, Hawaii and the District of Columbia. New Jersey reported the lowest chronic disease rate in the nation, at 48.2%.
5. Cost is a barrier, but it doesn’t track neatly with checkup rates. Nationally, 13.9% of adults with a chronic condition said they skipped a needed physician visit in the past year because of cost, compared with 10.8% of adults without one. Among the seven states above the median on both measures, Oklahoma (17%), Arkansas (16.3%) and Wyoming (15.4%) exceeded the national rate. But cost barriers aren’t limited to that group. Rates were also high in Alabama (16.9%) and Louisiana (16.2%), where checkup rates are strong, and in Texas, which reported the highest rate in the nation at 19.8%.
6. For health systems, the split points to different challenges. In high-burden states with strong checkup rates, the pressure may show up in chronic care management, capacity and cost. In low-burden states with weak engagement, fewer annual visits mean fewer chances to screen patients and catch disease before it becomes more expensive to treat. In the seven states facing both, health systems contend with these pressures simultaneously.
Here’s how all 48 reporting jurisdictions compare:
Editor’s note: California, Mississippi and Nevada did not collect enough data to meet minimum reporting requirements in 2025 and are excluded, along with U.S. territories. “Above” and “below” median refer to the median of the 48 reporting jurisdictions: 56.65% for any chronic condition and 19.95% for skipped checkups.
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