While Delaware climbed one spot higher in a recent national health ranking, it's still considered to be one of the less healthy states because of high rates of infant mortality and drug-related deaths.

The United Health Foundation on Dec. 12 released its annual America's Health Rankings report, which measures behaviors, the community and environment, clinical care and health outcomes of every state.

Delaware rose from 31st in 2016 to 30th this year but ranked 48th in infant mortality and 40th in drug deaths. The state was also second to last in disparity in health status, which looked at the health of Delaware adults aged 25 or older with a high school diploma or more education, compared to the health of adults who didn't finish high school.

Massachusetts was deemed the healthiest state while Mississippi was named the unhealthiest state for the second year in a row.

This year, the report looked into the concentration of health care providers and found there was a wide variation in states. In recent years, the Delaware medical community has raised concerns about a national shortage of primary care physicians and OB-GYNs.

Delaware is one of three states that has fewer than 45 dentists per 100,000 people, the report said.

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Dr. Karyl Rattay, director of the Division of Public Health, said the state uses this report as a "surveillance tool" when looking at large health trends in Delaware. Yet she said health officials "express some caution" about the actual rankings.

Because Delaware is such a small state, its numbers are extremely low. This makes it difficult to compare progress on yearly data. Instead, the state usually looks at trends on a five-year average, she said.

"We're not a very healthy state and we're not able to get out of the bottom half in a lot of indicators," she said. "We have made some great progress."

The report showed improvements such as: Delaware was ranked fifth in the country for health care policy, and cancer deaths have decreased by 3 percent in the last five years. The state also has a low uninsured rate of 5.8 percent.

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But Delaware has the second largest disparity in health status. The report defines high health status as the percentage of people reporting their health as very good or excellent. In the First State, 34.7 percent more of the educated said their health was good, and the report calls that number the health disparity.

While one's education level often influences health outcomes, there are several other factors, including race and ethnicity, that lead to disparities in health status, Rattay said.

"It's absolutely not just the only one," she said.

Dr. Craig Butler, chief medical officer for UnitedHealthcare of Delaware and Pennsylvania, said education is a socioeconomic indicator of income. Previous studies have shown that people with a high educational level and high income are more likely to be healthy.

"It's dangerous and life-threatening to be poor," he said.

The report also highlighted the national concern of infant mortality, Butler said. The U.S. rate of infant mortality has been consistently higher than most developed countries.

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The state was ranked 48th and 44th in infant mortality and low birth weight.

In Delaware, there are 7.9 infant deaths per 1,000 lives. Nationally, the leading causes of infant mortality are congenital malformation, low birth weight and preterm birth and maternal complications, the report said.

The percentage of Delaware babies born with a low birth weight has increased from 8.3 to 9.3 percent in 2017, the report said.

Low birth weight babies are also expensive: Hospital stays for these infants cost about $76,700 nationally compared to $1,000 for babies born at a normal weight, the report said.

Infant mortality is one of the "most serious issues" and is a good indicator about the healthiness of the state, Rattay said. While Delaware has seen "significant decreases" in the past decade, it's still about the national average.

The First State has a high unintended pregnancy rate, which can be connected to some unhealthy behaviors in expecting mothers. In 2010, 57 percent of all pregnancies in Delaware were unintended, according to the Guttmacher Institute.

Delaware also has high rates of obesity, diabetes, cardiovascular disease in women of childbearing age, which can also be attributed to the high infant mortality rate, Rattay said.

Butler believes that in general, the poor distribution of health care providers is a factor for infant mortality and low birth weights. Low-income areas tend to have fewer health care providers and as a result, women don't have easy access to care early in their pregnancy, he said.

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One of the most severe increases highlighted in the report was the number of drug-related deaths in Delaware. In the past 10 years, the state has seen a 147 percent increase, going from 8.1 to 20 deaths per 100,000 people.

Like thousands throughout the country, many Delawareans are suffering from an addiction to heroin. Last year, 308 people died in Delaware from a drug-related overdose. There have been 225 suspected overdoses reported this year.

Contact Meredith Newman at (302) 324-2386 or at mnewman@delawareonline.com. Follow her on Twitter at @merenewman.