WASHINGTON – People in Massachusetts, New York, Connecticut and Rhode Island spent 15 percent more on personal health care than the rest of the country in 1998, mostly because they have higher incomes and costs are greater in cities, the government says.

Utah, Idaho, Arizona, Nevada and New Mexico were among states with the lowest per capita health care spending, according to the survey by the Department of Health and Human Services’ Centers for Medicare and Medicaid Services.

Some states saw huge growth. Maine’s health spending per resident rose 7.3 percent annually, from $2,464 in 1991 to $4,025 in 1998.

Overall, however, the Plains region – which includes Kansas, Minnesota and Missouri – had the fastest average annual growth, 5.9 percent.

“Urban areas in general tend to be higher-priced than rural areas,” said Anne Martin, one of the report’s authors. “There’s also more concentration of population that can support teaching hospitals and other specialized facilities that can cost more.”

Katie Levit, who is in charge of national health statistics for the agency, cautioned that the numbers cannot be used to determine if residents of one state are getting better health care than those of another.

“People in lower-spending states may be younger, may be healthier, may live in lower-cost areas,” Levit said. “It doesn’t necessarily mean they’re not getting adequate or effective care. More research needs to be done to unravel all of these effects.”

Personal health care spending includes amounts that a person and his health plan pay for such things as hospital care, physician services and prescription drugs.

Agency economists conducted the study by examining Internal Revenue Service receipts for for-profit health care businesses, the American Hospital Association’s annual survey of hospitals and other data on population, wages and salaries. The study appears Tuesday in the journal Health Affairs.

In 1998, personal health care spending in the United States totaled $1 trillion. The national average per resident was $3,759.

But in Massachusetts, which led all states, spending was $4,810 per resident. New York was $4,706 per resident while Connecticut was $4,656 and Rhode Island was $4,497.

Washington, D.C., had spending of $6,656 per resident.

On the other end, Utah had the lowest health spending for 1998 – just $2,731 per resident. Idaho spending was $3,035 per resident, Arizona was $3,100, Nevada $3,147 and New Mexico $3,209.