The South rightfully can be proud of its reputation for friendliness and top-notch cuisine. But it’s also where people requiring home health services likely are to be found in disproportionately high numbers, if new health-related rankings are accurate.

Mississippi now is the unhealthiest state in the nation, according to Sharecare. Arkansas rated third worst, followed by Kentucky and Alabama. In fact, West Virginia was the only non-Southern locale ranked among the five unhealthiest states.

“We are seeing shifts in rankings due in part to broadly lower levels of well-being in rural communities,” said Elizabeth Colyer, a spokeswoman for Sharecare.

Higher poverty rates in the South also have been linked to unhealthy lifestyle habits, including smoking and diets high in fat, sugar and salt. That often translates to an increased risk for metabolic diseases, joint and skeletal problems, cardiovascular diseases, hypertension, being overweight — and other problems that can drive the need for healthcare and home health care services.

Investigators used a two-pronged approach to determine overall scores. First, they measured individual risk factors across five health domains: purpose, social, financial, community and physical. They then added a social index that considered five interrelated domains: healthcare access, food access, resource access, housing and transportation, and economic security.

Hawaii was rated the nation’s healthiest state. Rounding out the top five were Massachusetts, New Jersey, New York and California.