These 10 States Have the Highest Fatal Accident Rates, Does North Carolina Make The List?

Accidents are the third leading cause of death in the U.S. The CDC counted 197,449 unintentional injury deaths in 2024, but the risk is much higher in some states than others. As a Raleigh, North Carolina personal injury law firm, we wanted to know where that risk is highest and how our home state compares.

So we ranked U.S. states by age-adjusted accidental death rate and looked at road crash deaths, drug overdoses, and medical malpractice claims in each. Alaska tops the list, where about 1 in 1,100 residents die in an accident. North Carolina misses the top 10 but ranks 16th in the nation. Its accidental death rate is about 20% above the national average, and its roads are deadlier than those in several states that ranked higher overall.

Between 197K and 222K people in the U.S. die from unintentional injuries each year, and the CDC counted 197,449 unintentional injury deaths in 2024 alone, making accidents the third leading cause of death nationwide.

How We Conducted the Study

We compared accident risk across states using three key factors. Road crashes and drug overdoses make up the largest share of fatal accidents and injuries in America. Medical malpractice claims add context about harmful medical events and what they cost families.

Motor vehicle death rates match the 2024 state figures published by the Insurance Institute for Highway Safety, based on federal crash data. Drug overdose death rates match the CDC’s Stats of the States data. Malpractice figures reflect 2025 National Practitioner Data Bank payment reports measured against each state’s population.

We ranked states by their overall accidental death rate, age-adjusted so that states with older or younger populations could be compared fairly. Because our firm serves families across North Carolina, we added our home state to the chart below the top 10 so readers can see exactly how it compares on every measure.

The States With the Highest Accidental Death Rates Including North Carolina

You can access the full report findings by following this link.

State-by-State Breakdown

For each of the top five states, we also note how North Carolina compares.

1. Alaska

• Motor vehicle deaths: 9.5 per 100K residents
• Drug overdose deaths: 45.1 per 100K
• Medical malpractice claims: 1.62 per 100K
• Average payout per malpractice claim: $1.01M
• Accidental death rate (age-adjusted): 91.4 per 100K

Alaska has the highest risk of fatal accidents in the country, with roughly 1 in 1,100 residents dying this way. Overdoses are the most common cause, claiming 1 in 2,220 residents. Road deaths are much less common than in other top-ranked states like New Mexico or West Virginia, but the rate still reaches 9.5 per 100K. Malpractice claims are relatively rare, at 1.62 per 100K residents, but the average payout reaches $1.01M, which points to how serious these cases tend to be.

How North Carolina compares. Alaska’s overall accidental death rate is about 40% higher than ours. Our roads are the bigger danger, though. North Carolina’s crash death rate of 14.7 per 100K is more than 50% higher than Alaska’s.

2. West Virginia

• Motor vehicle deaths: 14.5 per 100K residents
• Drug overdose deaths: 48.9 per 100K
• Medical malpractice claims: 3.67 per 100K
• Average payout per malpractice claim: $373,846
• Accidental death rate (age-adjusted): 87.6 per 100K

West Virginia ranks second and has the highest drug overdose rate in the country. Accidental drug deaths claim 1 in 2,044 residents, more than twice as often as in Mississippi and four times as often as in South Dakota. The roads are dangerous too, with 14.5 motor vehicle deaths per 100K residents, or about 1 in 6,900.

How North Carolina compares. West Virginia’s overdose rate is nearly twice North Carolina’s 25.7 per 100K. On the road, the two states are almost even, and North Carolina’s crash death rate is slightly higher.

3. New Mexico

• Motor vehicle deaths: 19.2 per 100K residents
• Drug overdose deaths: 37.1 per 100K
• Medical malpractice claims: 8.40 per 100K
• Average payout per malpractice claim: $415,754
• Accidental death rate (age-adjusted): 79.3 per 100K

New Mexico has the second-most dangerous roads in the country, just behind Mississippi. Its rate of 19.2 motor vehicle deaths per 100K residents means about 1 in 5,200 people die on the road. Malpractice claims are also very common here, at 1 in 12K residents. That is more than twice the rate in West Virginia and five times the rate in Alaska. The average payout is only $415.7K, which often falls short of covering the full financial cost of that kind of loss.

How North Carolina compares. New Mexico’s malpractice claim rate is nearly eight times North Carolina’s 1.07 per 100K. Average payouts in the two states are close, at $415,754 in New Mexico and $401,610 in North Carolina.

4. Tennessee

• Motor vehicle deaths: 16.6 per 100K residents
• Drug overdose deaths: 35.2 per 100K
• Medical malpractice claims: 1.38 per 100K
• Average payout per malpractice claim: $458,400
• Accidental death rate (age-adjusted): 75.0 per 100K

Tennessee ranks fourth, with roughly 1 in 1,350 residents dying in an accident. Drug overdoses are the most common cause, at 35.2 deaths per 100K, nearly matching New Mexico. The roads are risky too, with 1 in 6,000 Tennesseans dying in a crash.

How North Carolina compares. Tennessee is our western neighbor and the only state bordering North Carolina to make the top 10. It has higher rates than we do on every measure of death in our study, including crash deaths (16.6 vs. 14.7) and overdoses (35.2 vs. 25.7). Families in western North Carolina, including those near our Asheville office, often drive the interstate corridors connecting the two states.

5. Oklahoma

• Motor vehicle deaths: 15.7 per 100K residents
• Drug overdose deaths: 25.5 per 100K
• Medical malpractice claims: 2.78 per 100K
• Average payout per malpractice claim: $475,351
• Accidental death rate (age-adjusted): 74.0 per 100K

Oklahoma rounds out the top five, with an accidental death rate of 74 per 100K residents. It trails Tennessee closely but has about twice as many malpractice claims. The claim rate is 2.78 per 100K, or 1 in 36K residents. Overdoses are slightly less common than in Tennessee, but the rate is still high at 25.5 per 100K.

How North Carolina compares. Oklahoma’s overdose rate of 25.5 per 100K is almost the same as North Carolina’s 25.7. Its crash death rate is only one point higher than ours, which shows how close North Carolina’s roads come to those in top-five states.

North Carolina: Ranked 16th in the Nation

• National rank: 16th
• Motor vehicle deaths: 14.7 per 100K residents
• Drug overdose deaths: 25.7 per 100K
• Medical malpractice claims: 1.07 per 100K
• Average payout per malpractice claim: $401,610
• Accidental death rate (age-adjusted): 64.2 per 100K

North Carolina’s age-adjusted accidental death rate of 64.2 per 100K residents means roughly 1 in 1,560 people died in an accident in 2024. That is 7,547 North Carolinians in a single year. Our rate is about 20% higher than the national rate of 53.3, and it is higher than the rates in Georgia (48.5) and Virginia (43.4). Among our neighbors, only Tennessee (75.0) and South Carolina (67.3) rank higher.

There is some good news. North Carolina’s accidental death rate has fallen from 80.0 in 2022 to 71.7 in 2023 and 64.2 in 2024, a drop of nearly 20% in two years. It is still above the state’s 2019 rate of 56.1.

Our Roads Are the Biggest Concern

North Carolina recorded 1,619 motor vehicle deaths in 2024, or about 1 in 6,800 residents. Our crash death rate of 14.7 per 100K is about 28% higher than the national rate of 11.5 and ranks 15th highest in the country. It is higher than four of the top-10 states in our study (West Virginia, Maine, Vermont, and Alaska) and well above Georgia (12.5) and Virginia (10.4). South Carolina, at 18.9, is the only neighbor with more dangerous roads besides Tennessee.

For families in Raleigh, Charlotte, Durham, Greenville, and Winston-Salem, a crash remains one of the most likely causes of sudden, preventable loss. A North Carolina car accident lawyer can help families after collisions involving passenger cars, commercial trucks, motorcycles, and pedestrians.

Overdoses Are Falling, but Still High

North Carolina’s overdose rate of 25.7 per 100K is almost identical to Oklahoma’s. The trend is improving. The North Carolina Department of Health and Human Services reports that overdose deaths fell 34%, from 4,442 in 2023 to 2,934 in 2024, the first decline since 2019.

Falls Are a Hidden Risk

Falls are one of the leading causes of accidental death in our state. North Carolina’s Division of Public Health counted 1,985 unintentional fall deaths in 2024. When a fall happens because a property owner ignored a hazard, a premises liability lawyer can help the family hold them accountable.

Malpractice Claims Are Less Common

North Carolina’s malpractice claim rate of 1.07 per 100K is lower than every top-10 state except Maine. National Practitioner Data Bank figures show 118 malpractice payments in North Carolina in 2025. Our average payout of $401,610 falls near the middle of the top-10 states, above West Virginia, Maine, Vermont, Arizona, and Mississippi.

Why Distance to Care Matters

Robert E. Whitley of Whitley Law Firm commented on the findings.

“Alaska leads in both unintended injuries and workplace deaths (14.1 per 100K workers) for the same reason that goes beyond dangerous industries or bad roads. Many Alaskan communities are accessible only by plane or boat, which means long distances to trauma care directly worsen accident outcomes. A serious injury that would be survivable in a state with a Level 1 trauma center 20 minutes away becomes fatal when the nearest medical facility is a two-hour flight in unpredictable weather. The same goes for communities that have no urban centers for hundreds of miles: for them even non-fatal injury carries a much larger risk.”

– Robert E. Whitley, Whitley Law Firm

The same problem exists on a smaller scale here at home. In rural parts of eastern North Carolina and the western mountains, response times and the distance to a trauma center can decide how a serious crash or workplace injury turns out. Families near our Kinston, New Bern, and Jacksonville offices know how far the nearest major hospital can be.

What These Numbers Mean for North Carolina Families

North Carolina sits just outside the 10 most dangerous states for fatal accidents, but our numbers tell a clear story. Our accidental death rate is about 20% above the national average, and our roads are deadlier than those in several states that ranked higher overall. Progress since 2022 shows these deaths can be prevented. When an accident is caused by someone else’s carelessness, North Carolina families should not have to carry the cost alone.

We are a family-owned firm with more than 120 years of combined attorney experience, and we help North Carolina families after serious injuries and losses from 10 offices across the state, from Asheville to New Bern. You can see some of our case results or meet our team.

If you or someone you love was hurt in a crash or lost a family member to a preventable accident, talk to a car accident lawyer who knows North Carolina. Contact Whitley Law Firm today for a free consultation.