WASHINGTON » Hawaii is the fifth healthiest state for seniors, according to a new report from the United Health Foundation, a nonprofit arm of the insurer UnitedHealthGroup.

Massachusetts passed Hawaii, ranked fourth last year, and replaced Vermont as the healthiest state for seniors, while Louisiana ranks as the unhealthiest for the second-straight year, according to the report, released last week.

The 2016 “America’s Health Rankings Senior Report” used 35 health data measures to grade each state’s performance in providing a healthy environment for residents age 65 and older.

The report said Hawaii ranks low in the prevalence of obesity, preventable hospitalizations and hip fracture rates. But needs to improve with a high prevalence of excessive drinking, a low percentage of seniors who report their health is very good or excellent, and a high percentage of senior deaths in hospitals.

Despite the hospital death rate, Hawaii had the fewest deaths per 100,000 adults ages 65 to 74 among all states. The national average is 1,786. Hawaii had the fewest, with 1,394.

Efforts by Massachusetts seniors to cut smoking and increase physical activity and flu vaccinations helped it reach the top spot after finishing 6th in 2015. Vermont finished second, followed by New Hampshire, Minnesota and Hawaii.

High rates of smoking, obesity and physical inactivity among seniors kept Louisiana in last place for the second-straight year. Along with Oklahoma and Mississippi, Arkansas and West Virginia rounded out the five lowest-ranked states.

Nationally, seniors have improved their health status over the last three years as the number of home health care workers increased and the number of preventable hospitalizations, teeth extractions and hip fractures declined.

But increases in obesity and hunger and a decline in home-delivered meals, access to food stamps and financial support for seniors in poverty, contributed to an overall “mixed picture” on seniors’ health, said Rhonda Randall, senior adviser to the United Health Foundation.

Improving seniors’ health is complicated, as millions of aging baby boomers fuel a growth spurt among the elderly, many of whom have multiple chronic diseases.

By 2030, the number of seniors is expected to increase to 73.8 million, from 49.4 million this year, Randall said.

Star-Advertiser web producer Craig Gima contributed to this story.