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ATLANTA – Kentucky and West Virginia — where people traditionally smoke the most — have the highest death rates from smoking, a new federal study has found. Rounding out the 10 states with the highest average annual smoking death rates were Nevada, Mississippi, Oklahoma, Tennessee, Arkansas, Alabama, Indiana and Missouri.

The lowest death rates were in Utah and Hawaii, according to the U.S. Centers for Disease Control and Prevention study.

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. And it was nearly three times the rate for Utah, which was 138 per 100,000.

The smoking death rates were calculated using death certificate data from the years 2000 through 2004, focusing on lung cancer and 18 other diseases caused by cigarette smoking.

The rates track pretty closely with the adult smoking rates in each state. Kentucky and West Virginia had the highest smoking rates in 2004 as well.

But obesity and other problems that trigger heart disease are also factors. Smoking, added to those problems, "is like gasoline on the fire," said Terry Pechacek, a CDC senior scientist for tobacco-related issues.

For every state, the annual number of smoking deaths was higher among males than females. However, rates declined in men in 49 states since the late 1990s, but declined in women in only 32 states.

The report is published this week in the CDC's Morbidity and Mortality Weekly Report.