About 14 million major medical conditions in the US can be blamed on smoking, according to a study by health officials.

Using surveys, the researchers found that in 2009 roughly seven million Americans reported almost 11 million major medical conditions caused by smoking. Including ailments people don’t know they have or didn’t report, that number climbs to 14 million medical conditions.

These numbers are up from the 12.7 million medical conditions estimated 10 years ago by the CDC.