LOS ANGELES (CBSLA) — For the 19th year in a row, the Los Angeles-Long Beach area has been named the most polluted city in the nation, according to the American Lung Association.

But the rest of California is in the same smoggy boat – eight of the country’s 10 most polluted cities are in the Golden State.

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This year, two heavily populated counties in California — San Bernardino County and Los Angeles County — lacked year-round particle-pollution data, according to the report. Had data been available from those two counties, which traditionally have unhealthful levels of all three measures, the actual number would likely be much higher, likely 19 million people.

With respect to ozone pollution, “Los Angeles remains at the top of this list, as it has for all but one of the 19 reports. Los Angeles also recorded more unhealthy air days in this report, measured in the weighted average, a change from last year when it reached its lowest level ever.”

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The annual “State of the Air” report says ozone pollution has worsened since previous reports, even as improvements continue in year-round particle pollution and fewer episodes of high-particle days. That has contributed to the number of people exposed to unhealthy levels of air pollution increasing to more than 133.9 million people during the period covered by the 2017 report (2013-2015).

“The State of the Air 2018 shows that too many people in the United States live where the air is unhealthy for them to breathe,” the report says. “More than four in 10 people (41.4 percent) in the United States live in counties that have unhealthful levels of either ozone or particle pollution.

The report “adds to the evidence that a changing climate is making it harder to protect human health,” it said, adding that with record-setting heat in 2016, high ozone days zoomed, putting millions more people at risk and adding challenges to the work cities are doing across the nation to clean up. Only Clean Air Act enforcement will “enable the nation to continue to protect all Americans from the dangers of air pollution.”

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(© Copyright 2018 CBS Broadcasting Inc. All Rights Reserved. City News Service contributed to this report.)