Abruptly losing a loved one in an accident is one of life’s greatest tragedies. While often regarded as rare, approximately one American dies in an accident every four minutes. In fact, fatalities from car crashes, drug overdoses, and other accidents are the most common types of death in the first half of an American’s life.

Nationwide, 43.2 Americans died as a result of some form of accident for every 100,000 people in 2015, but not all states report the same rate of deadly accidents. In Maryland, 29.7 people died of accidents per 100,000 state residents — the state where deadly accidents are most rare. West Virginia has the highest rate of deaths from accidents with 77.9 deaths per 100,000 residents.

23. Arizona

> Accidental death rate: 49.2 (per 100,000)
> Accidental deaths: 3,539
> Leading cause of accidental death: Poison
> Accidental deaths from drug overdoses: 998

With data from the Centers for Disease Control and Prevention, 24/7 Wall St. reviewed the accidental death rate in every state.

Poisoning is the leading cause of accidental death nationwide, and the vast majority of these deaths are from accidental drug overdoses. Opioid overdoses have quadrupled since 1999 and are the most common form of drug overdose.

Accidental drug overdose rates vary more between states than any other leading cause of accidental death and explain much of the variances between states. In West Virginia, for example, the unintentional overdose rate of 37.2 per 100,000 residents is over six times higher than in Maryland, the state with the lowest rate of accidental drug overdoses.

After poisoning, motor vehicle accidents and falls are the next leading causes of accidental death. Combined with poisoning, these three causes account for 79% of all accidental deaths nationwide.

Many steps have been taken to reduce the likelihood of a deadly accident. Between 1975 and 2008, seat belts saved an estimated 255,000 lives. Exercise programs for older adults have helped reduce falls in some areas by as much as 50%. However, the explosion of opioid use has overshadowed these and other improvements as the accidental death rate has risen for the sixth year in a row.

To determine the states with the most and least deadly accidents, 24/7 Wall St. reviewed the 2015 accidental death rate in each state with data from the Centers for Disease Control and Prevention. The number of accidental deaths, the leading cause of accidental deaths, as well as the number of accidental deaths from falls, drug overdoses, and motor vehicle accidents were also obtained from the CDC.

Click here to see the states with the most fatal accidents.