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The most stressed-out cities in America

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Photo Credit: Alamy Stock Photo

It’s no secret that 2020 was an extremely stressful year for almost everyone. Early in the year, COVID-19 began to spread far and wide, bringing life to a halt with stay-at-home orders in the spring. People transitioned to working and schooling virtually, and the shutdowns and accompanying shifts in consumer patterns created economic shocks that disrupted many sectors. Record numbers of Americans began applying for unemployment benefits and struggled to afford basic necessities like food and housing. On top of that, the U.S. was in the midst of a grueling, bitterly contested election cycle with constant news coverage adding to Americans’ mental burdens. And due to efforts to stop the spread of the coronavirus, many of the comforts people look to for stress relief—an exercise class at the gym, a night out at a restaurant or concert, a religious service at a house of worship, simple quality time with family and friends—have been disrupted, transformed, or simply unavailable for much of the last year.


While it feels like the last year elevated stress to all-time highs, the U.S. is a stressed-out country in general. Worldwide polling from Gallup finds that Americans express feelings of stress, worry, and anger more frequently than populations in almost every other country. This matters because chronic stress disturbs the immune, digestive, cardiovascular, sleep, and reproductive systems and increases susceptibility to serious conditions like heart disease and diabetes. Americans’ high levels of stress could be one of the reasons why the U.S. trails many other developed nations with regards to health and life expectancy.

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One of the issues that makes stress a particularly challenging health issue is that many of the factors contributing to stress are self-reinforcing. For instance, a low income may make it difficult for a family to find affordable, quality housing; substandard housing may increase the family’s risk for health conditions like asthma or poor nutrition; and the costs of treating those health conditions may put even more strain on the family’s finances. The combined health and economic effects create even more worry, uncertainty, and stress for the family.

Because of that reinforcing cycle, one factor highly correlated to stress levels is economic insecurity. Households that struggle to secure basic necessities like steady income, safe housing, and healthy food are more likely to experience high levels of stress and the accompanying effects. This means that many of the areas experiencing the highest levels of stress are also likely to be the areas experiencing high levels of poverty and economic insecurity.



Indeed, the map of the most-stressed states shows high levels of vulnerability in the Southeast, which is also where most of the highest-poverty states in the U.S. are located. Mississippi is both the poorest and most stress-prone state, while neighboring Louisiana is second for both categories. At the local level, many of the same patterns hold—many of the most vulnerable cities tend to be located in the high-poverty Southeast or in other economically distressed areas like the Rust Belt.

To identify these stressful locations, researchers at RetailMeNot created a composite measure based on CDC and Census data about factors that contribute to stress. These include measures for self-reported mental and physical health, economic indicators like poverty and economic inequality, and health behaviors like good sleep and physical activity.

Here are the most stress-prone cities in the U.S.



Top 15 cities in the US with the highest rates of distress

The Most Stressed-Out Large Cities in the U.S.

Photo Credit: Alamy Stock Photo

15. Jacksonville, FL

  • Composite stress score: 67.30
  • Population reporting poor mental health: 15.8%
  • Population reporting poor physical health: 13.9%
  • Population without health insurance: 12.8%
  • Median housing costs as a percentage of income: 23.2%
  • Poverty rate: 14.1%
  • Gini index of economic inequality: 0.4620
  • Population sleeping <7 hours/night: 40.4%
  • Population reporting no leisure time physical activity: 28.3%

Photo Credit: Alamy Stock Photo

14. Las Vegas, NV

  • Composite stress score: 68.40
  • Population reporting poor mental health: 14.8%
  • Population reporting poor physical health: 14.9%
  • Population without health insurance: 13.2%
  • Median housing costs as a percentage of income: 24.1%
  • Poverty rate: 14.9%
  • Gini index of economic inequality: 0.4926
  • Population sleeping <7 hours/night: 38.6%
  • Population reporting no leisure time physical activity: 27.4%

Photo Credit: Alamy Stock Photo

13. Tulsa, OK

  • Composite stress score: 69.29
  • Population reporting poor mental health: 16.2%
  • Population reporting poor physical health: 14.5%
  • Population without health insurance: 16.6%
  • Median housing costs as a percentage of income: 21.1%
  • Poverty rate: 18.6%
  • Gini index of economic inequality: 0.5287
  • Population sleeping <7 hours/night: 35.8%
  • Population reporting no leisure time physical activity: 27.7%

Photo Credit: Alamy Stock Photo

12. Baltimore, MD

  • Composite stress score: 71.09
  • Population reporting poor mental health: 15.3%
  • Population reporting poor physical health: 13.7%
  • Population without health insurance: 5.8%
  • Median housing costs as a percentage of income: 26.9%
  • Poverty rate: 20.2%
  • Gini index of economic inequality: 0.5124
  • Population sleeping <7 hours/night: 44.2%
  • Population reporting no leisure time physical activity: 27.1%

Photo Credit: Alamy Stock Photo

11. Fresno, CA

  • Composite stress score: 71.43
  • Population reporting poor mental health: 15.1%
  • Population reporting poor physical health: 16.2%
  • Population without health insurance: 8.2%
  • Median housing costs as a percentage of income: 25.8%
  • Poverty rate: 23.2%
  • Gini index of economic inequality: 0.4653
  • Population sleeping <7 hours/night: 38.6%
  • Population reporting no leisure time physical activity: 29.0%

Photo Credit: Alamy Stock Photo

10. Tampa, FL

  • Composite stress score: 72.50
  • Population reporting poor mental health: 15.0%
  • Population reporting poor physical health: 14.2%
  • Population without health insurance: 11.7%
  • Median housing costs as a percentage of income: 25.1%
  • Poverty rate: 17.0%
  • Gini index of economic inequality: 0.5288
  • Population sleeping <7 hours/night: 38.5%
  • Population reporting no leisure time physical activity: 28.3%

Photo Credit: Alamy Stock Photo

9. Dallas, TX

  • Composite stress score: 72.85
  • Population reporting poor mental health: 14.1%
  • Population reporting poor physical health: 13.9%
  • Population without health insurance: 24.6%
  • Median housing costs as a percentage of income: 24.8%
  • Poverty rate: 17.5%
  • Gini index of economic inequality: 0.5369
  • Population sleeping <7 hours/night: 37.3%
  • Population reporting no leisure time physical activity: 29.5%

Photo Credit: Alamy Stock Photo

8. Milwaukee, WI

  • Composite stress score: 73.25
  • Population reporting poor mental health: 15.8%
  • Population reporting poor physical health: 16.9%
  • Population without health insurance: 10.2%
  • Median housing costs as a percentage of income: 24.4%
  • Poverty rate: 22.4%
  • Gini index of economic inequality: 0.4556
  • Population sleeping <7 hours/night: 38.7%
  • Population reporting no leisure time physical activity: 30.0%

Photo Credit: Alamy Stock Photo

7. New Orleans, LA

  • Composite stress score: 74.35
  • Population reporting poor mental health: 15.9%
  • Population reporting poor physical health: 14.0%
  • Population without health insurance: 8.6%
  • Median housing costs as a percentage of income: 27.9%
  • Poverty rate: 23.2%
  • Gini index of economic inequality: 0.5781
  • Population sleeping <7 hours/night: 37.6%
  • Population reporting no leisure time physical activity: 26.8%

Photo Credit: Alamy Stock Photo

6. Houston, TX

  • Composite stress score: 75.31
  • Population reporting poor mental health: 13.5%
  • Population reporting poor physical health: 14.0%
  • Population without health insurance: 25.2%
  • Median housing costs as a percentage of income: 24.9%
  • Poverty rate: 19.7%
  • Gini index of economic inequality: 0.5356
  • Population sleeping <7 hours/night: 38.6%
  • Population reporting no leisure time physical activity: 30.9%

Photo Credit: Alamy Stock Photo

5. Philadelphia, PA

  • Composite stress score: 80.04
  • Population reporting poor mental health: 18.0%
  • Population reporting poor physical health: 15.2%
  • Population without health insurance: 8.1%
  • Median housing costs as a percentage of income: 25.7%
  • Poverty rate: 23.3%
  • Gini index of economic inequality: 0.5288
  • Population sleeping <7 hours/night: 45.4%
  • Population reporting no leisure time physical activity: 27.5%

Photo Credit: Alamy Stock Photo

4. Cleveland, OH

  • Composite stress score: 86.35
  • Population reporting poor mental health: 19.4%
  • Population reporting poor physical health: 18.5%
  • Population without health insurance: 7.2%
  • Median housing costs as a percentage of income: 26.8%
  • Poverty rate: 30.8%
  • Gini index of economic inequality: 0.4936
  • Population sleeping <7 hours/night: 50.3%
  • Population reporting no leisure time physical activity: 36.9%

Photo Credit: Alamy Stock Photo

3. Detroit, MI

  • Composite stress score: 87.35
  • Population reporting poor mental health: 19.0%
  • Population reporting poor physical health: 20.7%
  • Population without health insurance: 8.2%
  • Median housing costs as a percentage of income: 25.8%
  • Poverty rate: 30.6%
  • Gini index of economic inequality: 0.5137
  • Population sleeping <7 hours/night: 51.4%
  • Population reporting no leisure time physical activity: 37.7%

Photo Credit: Alamy Stock Photo

2. Miami, FL

  • Composite stress score: 87.99
  • Population reporting poor mental health: 15.0%
  • Population reporting poor physical health: 15.8%
  • Population without health insurance: 19.0%
  • Median housing costs as a percentage of income: 36.3%
  • Poverty rate: 20.3%
  • Gini index of economic inequality: 0.5514
  • Population sleeping <7 hours/night: 39.6%
  • Population reporting no leisure time physical activity: 33.4%

Photo Credit: Alamy Stock Photo

1. Memphis, TN

  • Composite stress score: 89.80
  • Population reporting poor mental health: 17.9%
  • Population reporting poor physical health: 17.6%
  • Population without health insurance: 14.5%
  • Median housing costs as a percentage of income: 24.9%
  • Poverty rate: 21.7%
  • Gini index of economic inequality: 0.5205
  • Population sleeping <7 hours/night: 47.8%
  • Population reporting no leisure time physical activity: 35.5%

Methodology & Detailed Findings

To identify the most stressed-out cities and states in the U.S., researchers at RetailMeNot created a composite score using the following metrics:

  • Population reporting poor mental health: Adults who reported 14 or more days per month with poor physical health
  • Population reporting poor physical health: Adults who reported 14 or more days per month with poor mental health
  • Population without health insurance: The uninsured rate for the civilian noninstitutionalized population
  • Median housing costs as a percentage of income: Median monthly housing costs as a percentage of median monthly household income
  • Poverty rate: Percentage of the population below the poverty level
  • Gini index of economic inequality: A measure of income inequality that summarizes the distribution of income across the population; the index ranges from 0 (perfect equality, where everyone receives an equal share) to 1 (perfect inequality, where only one recipient receives all the income)
  • Population sleeping <7 hours/night: Adults who reported usually getting insufficient sleep (less than 7 hours in a 24-hour period)
  • Population reporting no leisure time physical activity: Adults who reported not participating in any physical activities or exercises (such as running, strength training, or golf) outside of their regular job

For each metric, a higher number was associated with a higher level of stress, and all metrics were weighted equally. To improve relevance, cities were grouped based on population size: small (100,000–149,999), midsize (150,000–349,999), and large (350,000 or more). All data was sourced from either the U.S. Centers for Disease Control and Prevention PLACES 2020 Release or the U.S. Census Bureau’s 2019 American Community Survey.

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