Knoxville News Sentinel reports that more than 50,000 people got sick or died from something they ate in a hidden epidemic that went undiagnosed by the nation’s public health departments over a five-year period.

Americans play a sort of food-poisoning Russian roulette depending on where they live, an investigation by Scripps Howard News Service found. Slovenly restaurants, disease-infested food-processing plants and other sources of infectious illness go undetected all over the country, but much more frequently in some states than others.