To study the incidence of fatal myocarditis in the general population, the authors retrospectively collected all death certificates recording myocarditis as the underlying cause of death in Finland in 1970-1998. The incidence of myocarditis and its proportion of all deaths were calculated from 141.4 million person-years and 1.35 million deaths. Myocarditis was recorded as the underlying cause of death in 639 cases. Thus, its death certificate-based incidence was 0.46 (95% confidence interval (CI): 0.43, 0.49) per 100,000 person-years, and it caused 0.47 (95% CI: 0.44, 0.51) of 1,000 deaths. The incidence of 0.51 (95% CI: 0.46, 0.56) in males was higher than the incidence of 0.42 (95% CI: 0.37, 0.47) in females, the odds ratio being 1.34 (95% CI: 1.15, 1.58) (p