BACKGROUND: When entering the profession, pilots need to be in better health than the general population. During their careers they are under close medical supervision, which could influence their life-long mortality. METHODS: The cohort was established from the files of the Norwegian Civil Aviation Administration and included people who had valid licenses as commercial pilots between 1946 and 1994. Basic data about their flight careers were recorded. The cohort was linked to the Cause of Death Registry. The observed number of deaths was compared with those expected, based on national rates. RESULTS: A group of 3707 male pilots was followed over 70,832 person-years. There were 342 deaths vs. 362.8 expected, with a standardized mortality ratio (SMR) of 0.94, and a 95% confidence interval (95% CI) of 0.85-1.05. Aircraft accidents with 97 deaths had a major influence on total mortality and the SMR for all other causes was 0.68 (95% CI 0.59-0.77). The SMR for cancer was 0.89 (95% CI 0.71-1.11) and for circulatory diseases 0.53 (95% CI 0.42-0.67). The highest SMR for total mortality in pilots