Eight of the 10 most dangerous cities for pedestrians are located in Florida, according to a 2016 study from Smart Growth America.

The Cape Coral-Fort Myers area was named the worst region for pedestrians, with Palm Bay and Orlando following closely behind, according to the “Dangerous by Design 2016” report. A total of 104 metro areas were analyzed for the study, each ranked by a “Pedestrian Danger Index.” The index is a calculation of the share of local commuters who walk to work as well as recent data on pedestrian deaths.

Miami, Fort Lauderdale and West Palm Beach are number 11 on the list, with a Pedestrian Danger Index of 145.1. Cape Coral’s PDI is 283.1, according to the study.

Florida had a total of 5,142 pedestrian deaths from 2005-2014. With an overall PDI of 177, this is the fourth consecutive year the state has topped the list of most dangerous cities for pedestrians.

Nationwide, more than 46,000 pedestrians were struck and killed by cars from 2005 to 2014, the study says. Here are the top 10 most dangerous areas identified by the study:

1 – Cape Coral-Fort Myers, Fla.

2 – Palm Bay-Melbourne-Titusville, Fla.

3 – Orlando – Kissimmee – Sanford, Fla.

4 – Jacksonville, Fla.

5 – Deltona-Daytona Beach – Ormond Beach, Fla.

6 – Lakeland-Winter Haven, Fla.

7 – Tampa, Fla.

8 – Jackson, Miss.

9 – Memphis, Tenn.

10 – North Port-Sarasota-Bradenton, Fla.