Age as well as the previous or present occupation of users are undoubtedly factors. Retirees in this area were predominantly engaged in physical labor where the effects bring on back, leg, foot, joint, and other pain. This is an issue with raising the Social Security retirement age, where studies reveal how people engaged in physical labor are disadvantaged compared with those who are not. The data also cannot account for Martinsville sales to residents of Henry and Patrick Counties which has the effect of exaggerating the city's average. Even considering that caveat, it's no surprise that Martinsville and the surrounding area are at or near the top.