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The US healthcare sector is rapidly becoming one of the leading sectors within the US economy with current healthcare spending at 17.9% of GDP. With the aging of the US population, chronic disease rates are increasing. For example, 133 million Americans, nearly 1 in 2 adults, suffer from chronic diseases that in-turn account for 7 in 10 deaths each year and more than 75% of health care costs. This paper analyzes the efficiency and performance analysis of 51 US states (including DC) from the perspective of chronic disease and prevention by using a Data Envelopment Analysis (DEA) approach. DEA is a non-parametric, robust, linear programming mathematical technique that has been applied in various fields. In this paper, four output (heart disease rate, obesity rate, diabetes rate, and colorectal cancer rate) and five input performance measures (total health spending of each state, physical activity, eating habits …