Puerto Rico reports the highest rates of poor physical health among all U.S. states and territories, according to new research published in JAMA Network Open. The study, led by Anna-Michelle McSorley of the University of Connecticut, used data from the Behavioral Risk Factor Surveillance System, one of the few federal datasets that includes U.S. territories.
McSorley found that 27.8% of Puerto Ricans reported fair or poor general health, compared to 16.1% in the 50 states. Guam and the U.S. Virgin Islands also reported higher rates at 17.7% and 18.6%, respectively. “From the data that I saw, it was pretty remarkable to note that Puerto Rico had the most disparities when compared to the 50 states,” McSorley said.
Mental health outcomes, however, showed less variation. Puerto Rico reported 12.8% of individuals experiencing poor mental health for 14 or more days in a month, close to the 14.9% reported in the states. “There actually wasn’t this stark disparity,” McSorley noted, though she emphasized the need for increased attention to mental health across all jurisdictions.
McSorley stressed that territories are often excluded from federal data systems, making it difficult to assess and address their public health needs. “If the data are not there, we don’t have the ability to tell the story about what the population health characteristics look like at baseline,” she said.
See “Health disparities in US territories: Puerto Rico reports highest rates of poor physical health compared to 50 states” (May 14, 2025)