Among the state’s 64 counties, rural areas with lower average incomes tend to experience unhealthier outcomes and shorter lives compared to their affluent or suburban counterparts, a new study found.

SmartAsset, a financial advice company, rated Douglas, Boulder and Pitkin counties as the healthiest through a combination of factors.

“Our study identified the healthiest counties in Colorado by considering length of life, health behaviors and healthcare access,” said A.J. Smith, vice president of financial education at SmartAsset, as reported in The Denver Post.

Not every county’s data were measured, but there were striking differences between even middle-ranked counties and the lowest ranked.

Denver, which SmartAsset listed as having the 21st-most healthy outcomes, had 131 primary care physicians per 100,000 residents, compared to 62 in Morgan County. El Paso County, ranked 24th, saw 7.1% of its residents uninsured, compared to 13.5% in Montezuma County.

While the suburban and rural divide in health outcomes was not absolute, the SmartAsset survey found that the Front Range counties generally had the best access to healthcare, measured in physicians per capita and rates of uninsurance.

The gap does not just extend to physical health: In 2018, the state’s Office of Rural Health reported that 22 rural counties are without a licensed psychologist. The suicide rates in rural parts of the state are on average 41% higher than Colorado as a whole.