A March 2021 JAMA Network study on the leading causes of death in 2020 noted increases in deaths from diabetes, Alzheimer's disease, and unintentional injury—even at the height of COVID-19. "Alzheimer's disease, and diabetes, may also reflect disruptions in health care that hampered early detection and disease management," the study's authors wrote. The Commonwealth Fund's annual Scorecard on State Health System Performance agrees with that assessment. "As evidenced by steep declines in outpatient visits during 2020, many Americans were forced to delay routine health services such as checkups, screenings, and chronic care management because of COVID-19 lockdowns and overwhelmed health care facilities," the Scorecard states. "Premature deaths from treatable conditions such as heart disease and diabetes, which can be managed through timely, high-quality care, jumped from 83.8 to 89.8 deaths per 100,000 population between 2019 and 2020." The report from Commonwealth aims to assess the health care system in all 50 states and the District of Columbia, and whether Americans are getting the care they need at the right time and without catastrophic hits to the wallet. The Scorecard also takes a look at the general health of America, the prevalence of high-risk behaviors and the chances of dying early from preventable diseases. For their 2022 report, Commonwealth added data showing how well each state's health care system responded to the COVID-19 pandemic, including the total number of days when at least 80 percent of ICU beds in each state were occupied. Among the 16 states that operated at high ICU capacity for at least 150 days between August 2020 and March 2022, Texas led at 566 days at or above 80 percent. Alabama followed at 517 days. Rhode Island, Mississippi, and Oklahoma were among the states exceeding 300 days at high ICU capacity. The report also revealed the devastating toll of drug overdoses during the pandemic. "After rising steadily through 2017, drug overdose deaths had leveled off by 2018–19," the Scorecard authors write. "However, immediately after the pandemic began, deaths spiked, as people dealt with physical isolation, disrupted addiction treatment, and a supply of deadlier drugs like fentanyl." West Virginia saw the highest percentage increase of overdose death rates, followed by the District of Columbia and Kentucky. For its overall health care rankings of each state, The Commonwealth Fund used 56 performance indicators grouped into five dimensions, including avoidable hospital use and cost, access and affordability, and healthy lives, which encompasses health risk behaviors and factors as well as state public health funding. There were also newly added dimensions related to income disparity and racial and ethnic health equity. See our slideshow above for the top and bottom five states for overall health care, and click here for the full report.