More than two-thirds of all homicides in the United States are gun-related. Of the 16, 121 homicides reported in 2013, 11,208 were caused by gun violence. Including suicides, nearly 34,000 people died in gun-related incidents in 2013, up 13.8% from 10 years earlier.

The Centers for Disease Control and Prevention (CDC) keeps track of the number of gun-related deaths in each state. Fatalities include homicides, suicides, and accidents. The frequency of firearm-related deaths varies considerably across the country. In Hawaii, the state with the fewest gun-related fatalities, there were just 2.6 firearm-associated deaths per 100,000 people. In Alaska, on the other hand, there were nearly 20 gun-related deaths per 100,000 residents, the most of any state. 24/7 Wall St. examined the 10 states with the highest gun-related deaths.

Click here to see the 10 states with the most gun violence.

Suicide is the leading cause of gun-related deaths across the country in recent years. Of the 33,636 firearm deaths in 2013, more than 21,000 were suicides. In fact, suicide accounted for more than half of gun-related deaths in all but one state with the most gun violence. In three states — Alaska, Montana, and Wyoming — suicide accounted for more than 80% of all firearm deaths.

24/7 Wall St. discussed the CDC’s figures with John Roman, senior fellow at the Urban Institute, an economic and social policy think tank. Roman explained that states with the highest rates of suicide often have the strongest culture of gun ownership in the country. “There are many more suicides in places where it’s easy to get a gun,” he said.

While federal gun laws are uniform across the country, state regulations vary, offering more lax or more strict approaches to firearm use. Seven of the 10 states with the most firearm deaths in 2013 have enacted stand your ground laws. In keeping with a state’s culture, Roman explained, many states with these laws likely also have laws that make it easier to possess firearms and buy ammunition.

In fact, none of the states with the most gun violence require permits to purchase rifles, shotguns, or handguns. Gun owners are also not required to register their weapons in any of these states. Meanwhile, many of the states with the least gun violence require a permit or other form of identification to buy a gun.

Gun-related homicides were also relatively frequent in the states with the most gun violence. Nationally, there were 3.61 homicides per 100,000 people. Seven of the the 10 states with the most gun violence reported homicide rates higher than the national rate. Louisiana is one of only four states in the country where homicides accounted for a larger share of firearm deaths than suicides. In 2013, Louisiana reported nearly 10 homicides per 100,000 residents, the highest rate in the country.

Although not necessarily related, violent crime rates in the states with the most gun violence were also quite high. In fact, in seven of these states there were more than 430 violent crimes reported per 100,000 residents. Nationally, the rate was 367.9 violent crimes per 100,000 Americans.

Limited access to quality hospitals may be a contributing factor to firearm deaths. Often, victims of gunshots or other violent crimes need immediate medical attention, which may be more difficult to receive in rural areas. “If you have a hospital with a Level III trauma center, your likelihood of surviving an injury like a gunshot wound is far higher than if you lived near a basic hospital,” Roman said.

Economic factors also appear to be related to firearm deaths. The poverty rate in eight of the 10 states with the most gun violence was above the national rate of 15.8%. Mississippi, New Mexico, Louisiana, and Arkansas, the states with the four highest poverty rates in the country, were among the states with the most gun violence.

Educational attainment rates also tended to be lower in states with the most gun violence. The share of adults with at least a bachelor’s degree was lower than the national rate of 29.6% in all 10 states on this list.

To determine the states with the most gun violence, 24/7 Wall St. examined 2013 firearm-related deaths data from the CDC. Firearm death rates are age-adjusted to avoid distortion in states with large populations of young people. We also considered 2013 violent crime rates from the Federal Bureau of Investigation’s Uniform Crime Report. From the U.S. Census Bureau, we reviewed median household income, poverty rates, and educational attainment rates for 2013. Information on firearm policies for each state are from the National Rifle Association’s (NRA) Institute for Legislative Action.

These are the states with the most gun violence.

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