Many Americans entering old age can look forward to a comfortable retirement, pursuing lingering life goals, and sharing a life of experience with younger generations. However, the physical decline that comes with aging brings a host of well-known disadvantages for going about daily life. While a trip or fall can be a forgettable event for a young adult, falling can be a life-changing — even fatal — event for the elderly.

Falls are the leading cause of fatal and nonfatal injuries among elderly Americans. In the United States, 2.8 million seniors are treated for fall injuries in emergency rooms every year.

26. Maryland

> Deaths from falls per 100,000 seniors: 62.2
> Population 65 and over: 14.1% (8th lowest)
> Seniors living in nursing home: 2.7% (24th lowest)
> Medicare spending per capita: $10,488 (6th highest)

Death rates from falls varies dramatically between states. To identify the states where the most elderly people die from falls, 24/7 Wall St. reviewed 2015 mortality rates for elderly populations in each state from the Centers for Disease Control and Prevention. Wisconsin has the highest rate with 135 deaths from falls for every 100,000 older residents. The incidence of elderly falling deaths in Wisconsin is over five times greater than in Alabama, the state with the lowest rate, at 26 deaths from falls for every 100,000 seniors in 2015.

Fatalities from fall injuries among the elderly are on the rise. While roughly 10,000 older Americans died a result of falls in 2000, roughly 29,000 died by 2015. This increase is not merely the result of a growing population. The population-adjusted rate has doubled since 2000 — from 30 deaths from falls for every 100,000 Americans 65 and over to 60 deaths per 100,000 in 2015.

While most falls do not cause any serious harm, one in five cause a broken bone, head injury, or other serious injury. Falls account for most traumatic brain injuries and 95% of hip fractures. Even when they are not hurt as a result of their fall, older people tend to become anxious of falling again and reduce their activity level as a preventative measure. However, this can actually lead to reduced strength, which further increases the likelihood of falling and being injured in the future.

A traumatic brain injury from a fall clearly increases the chance of dying, but even injuries such as hip fractures, can cause deaths in older people. Many hip fractures require surgery and extended hospital stays. Complications from these surgeries, as well as developing an infection like pneumonia, increase the likelihood of death after a hip fracture.

After age 65, the risk of serious fall continues to increase. People 85 and older are more than 20 times more likely to die from falling than people 65-69 years old, with a falling mortality rate of 250 per 100,000. The states with the highest elderly death rates from falling tend to be the states where people live longer. Nine of the 10 states with the highest mortality rate from falls have life expectancy longer than the national average. Of the 10 states with the lowest mortality rates from falls, seven have a lower life expectancy than the country as a whole.

The mortality rate from falls also varies between races. For every 100,000 white Americans, 66 died from falls in 2015, nearly triple the 23 per 100,000 mortality rate from falls for black Americans. Of the 25 states with the highest mortality rates from falls, 23 have populations with above-average white populations. This is the case in only 10 of the 25 states on the other end of the list.

A range of explanations could account for such a wide racial disparity in fall death rates. White Americans live longer than black Americans on average, for example, and the risk of physical injury increases with age. One factor influencing the large gap is that white people, even when controlling for age, are more likely than black people to develop osteoporosis — a bone disease that causes bones to be more susceptible to fracture.

Environmental factors in a state likely also play a role in the likelihood of falls. For example, states with the most deaths from falling such as Wisconsin, Minnesota, and Vermont tend to be in areas with cold winters and high amounts of snowfall, which create slippery conditions for walking. States with low mortality rates are more likely to be located in the south with much less snowfall and icy conditions.

To identify the states where the highest share of older people die from falls, 24/7 Wall St. reviewed 2015 crude mortality rates from falls per 100,000 people 65 years and older from the Centers for Disease Control and Prevention. The percentage of the population that is 65 years and older is also from the CDC. The share of people 65 years and older living in nursing homes is from the U.S. Census Bureau’s report, “65+ in the United States: 2010.” Medicare spending per capita is from the Centers for Medicare and Medicaid Services and is for 2014, the most recent period for which data is available. 2013 life expectancy at birth figures are provided by the Institute for Health Metrics and Evaluation (IHME), a global research center affiliated with the University of Washington.

Click here to see the states where older Americans are most likely to die from a fall.