A new report from the Surgeon General finds disparities in tobacco use persist by factors including race and ethnicity and levels of income and education. Other factors include sexual orientation and gender identity, occupation, geography and behavioral health status, according to ABC News.

Despite the nation’s substantial progress in reducing cigarette smoking and secondhand smoke exposure in the overall U.S. population, the two continue to cause almost half a million deaths a year – nearly one in five of all deaths, the report states.

According to a Department of Health and Human Services news release, the report found that cigarette smoking is higher among American Indian and Alaska Native people than other racial and ethnic groups, and smoking among men and women living in poverty is more than twice as common compared to those not living in poverty. Smoking is also higher among adults with lower levels of education; people who identify as gay, lesbian or bisexual; adults who work in manual labor and service jobs; people who reside in rural areas; adults who reside in the Midwest or South; and people living with a mental health condition or substance use disorder.