JEFFERSON CITY, Mo. (AP) — A new report says Missouri has seen a steady decline in the health of its residents.

The report by the Missouri Hospital Association notes that the state fell from 24th in 1990 to 42nd last year in health rankings produced by the United Health Foundation.

The hospital association says average life expectancies in St. Louis and parts of southeast Missouri now are lower than in some parts of the world that are considered less developed, such as Vietnam, Honduras and Venezuela.

The hospital organization says improved access to insurance could help address the state's poor health status. A separate report from the U.S. Census Bureau says 16 percent of Missourians under age 65 were uninsured in 2011.

The hospital group has been pushing for Missouri to expand Medicaid eligibility.

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