In the United States, stroke is the third leading cause of death and one of the major causes of serious, long-term disability among adults. Each year, approximately 500,000 persons suffer a first-time stroke, and approximately 167,000 deaths are stroke-related. This report presents national and state-specific death rates for stroke in 1999, which indicate state-by-state variations in both stroke-related death rates and the proportions of stroke decedents who die before transport to an emergency department (ED). Prevention through public and medical education remains a key strategy for reducing stroke-related deaths and disability.