A new study from the University of Connecticut reveals that residents of U.S. territories—Puerto Rico, Guam, and the U.S. Virgin Islands—report significantly worse physical health than those living in the 50 states. The findings highlight long-overlooked disparities in health outcomes for millions of Americans living outside the continental U.S.
Led by Anna-Michelle McSorley, the study used data from the Behavioral Risk Factor Surveillance System, one of the few federal tools 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 states. Guam and the U.S. Virgin Islands also reported higher rates—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. She emphasized that these regions are often excluded from federal health data systems, making it difficult to identify and address their needs.
Mental health outcomes were also concerning. While the disparities were less stark, poor mental health was still widely reported—12.8% in Puerto Rico, 12.4% in Guam, and 11.7% in the Virgin Islands, compared to 14.9% in the states.
McSorley plans to expand her work to include mental health crisis response systems in the territories, noting the urgent need for more inclusive public health strategies.
See: “Study Demonstrates Health Disparities in U.S. Territories” (May 14, 2025)