MINNEAPOLIS — A new study says Minnesota residents have the fourth longest life expectancy in the country, with an average life span of almost 81 years.

The University of Washington’s Institute for Health Metrics and Evaluation published the study this week, The Star Tribune reports . The research ranked Minnesota behind Hawaii, California and Connecticut.

Minnesota men had an average life expectancy of almost 79 years, while women had nearly 83 years.

Healthy life expectancy is defined as years of life spent in full health. Minnesota’s healthy life expectancy ranked the highest in the country at about 70 years.

“Minnesota has a lot to be proud of and a lot to work on when it comes to public health,” said Jan Malcolm, commissioner for the state Health Department. “Our strong performance relative to other states is encouraging, but the report clearly shows big challenges that must be addressed.”

The study took into consideration about 330 diseases and injuries as well as more than 80 risk factors. Smoking is the top risk factor causing death and disability in Minnesota, the study found. Other factors included obesity, high plasma glucose, high blood pressure and alcohol use.

Low back pain and depression were the top health issues that caused Minnesota residents to live with years of disability. Diabetes and opioid use also dramatically increased in the state between 1990 and 2016, study authors wrote.

The five leading causes of death nationwide are heart disease; lung and trachea cancer; chronic obstructive pulmonary disease; Alzheimer’s disease and other dementias; and cancer of the colon and rectum, the study said.