Route 25 in Suffolk County has been ranked for the second year in a row as the road where the most pedestrians were killed in the metropolitan region.

Hempstead Turnpike isn't much better, according to the annual report by the Tri-State Transportation Campaign released Wednesday.

The campaign's study, which compiled federal accident statistics from 2011 to 2013 for roads in New York's 12 downstate counties, found that 20 people were killed on Route 25 -- known in various stretches as Jericho Turnpike, Middle Country Road and Main Street -- during that period. That's four more fatalities on the road than in last year's report by the watchdog group.

GraphicList: Worst roads in region

There were nine deaths on Suffolk's portion of Route 25 in 2011, six in 2012 and five in 2013, according to the study. Nearly half occurred on an 11.5-mile stretch from Centereach to Ridge.

Hempstead Turnpike in Nassau County, also known as Route 24, ranked second on the list, with 11 pedestrian deaths during the three years studied.

Other Long Island roads that made the list were Route 110 in Suffolk, which tied for fourth place with Merrick Road in Nassau County, both with nine deaths; Route 27A in Suffolk, which tied for fifth place with eight deaths; Sunrise Highway in Nassau, which tied for sixth place, at seven deaths; Route 25A in Suffolk, which had six fatalities, in a five-way tie for seventh place; and Sunrise Highway in Suffolk, which tied for eighth place with five deaths.

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The analysis examined pedestrian deaths on state, county and local roads but not fatalities on such roadways as interstates, where walking is prohibited. The analysis did not factor in length of roads or traffic volume.

The tri-state area in the study includes New Jersey and Connecticut.

Campaign executive director Veronica Vanterpool noted that, since the period used in the study, New York State has taken steps to make the "notoriously dangerous corridor" safer, including upgrading crumbling sidewalks, filling in gaps and installing better lighting along 4 miles of Route 25 in Riverhead.

But, Vanterpool said, the state Department of Transportation needs to do more to do more to transform Long Island's "outdated" roads that were designed with cars, not pedestrians, in mind.

Wide lanes, steel fences along sidewalks, and other pedestrian obstacles all serve to send a clear message, Vanterpool said: "You should not be walking here."

"At some of these roadways . . . it can be a half-mile before there's another crosswalk," Vanterpool said. "What we see consistently, year after year, is that Long Island is behind the curve as far as their road designs."

In a statement, DOT spokesman Beau Duffy said safety is the department's "number one priority," and noted that it has made several pedestrian safety improvements on both Routes 25 and 24, and plans more.

They include a $600,000 project on Route 25/Middle Country Road and Route 112 in Coram that will add new high-visibility crosswalks, countdown pedestrian signal timers, new and/or rebuilt traffic signals, and construction of two raised pedestrian islands.

The project is scheduled to begin in spring 2016 and be completed by fall 2018.

"We have also engaged local communities on the importance of using the crosswalks and pedestrian signals, as well as enforcing vehicle and traffic laws," Duffy said. "We will continue to work with our local partners to identify engineering, education and enforcement initiatives that will improve safety for all roadway users."