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Kentucky and West Virginia have the highest death rates from smoking, according to a new study by the U.S. Centers for Disease Control and Prevention.

Rounding out the top 10 states with the highest average annual smoking death rates were Nevada, Mississippi, Oklahoma, Tennessee, Arkansas, Alabama, Indiana and Missouri.

The smoking death rate in Kentucky was about 371 deaths out of every 100,000 adults age 35 and older. That was nearly one-and-a-half times higher than the national median of 263 per 100,000.

The CDC says smoking-related illnesses cost the state almost $4 billion in health-care costs.