OBJECTIVES: Cerebrovascular mortality has declined in the general population of Sweden. The objective of the present study was to investigate causes of death among stroke patients in a long-term perspective. RESEARCH DESIGN AND METHODS: A population-based study was conducted of first-ever strokes in the municipality of Söderhamn, Sweden. Standardized mortality ratios were calculated for comparison with the general population. Three time periods (1975 to 1978, 1983 to 1986, and 1987 to 1990) were analyzed. All 1186 patients were followed up for at least 10 years. RESULTS: Cerebrovascular mortality was greatly increased (more than 10-fold) in comparison with the general population during all study periods. The mortality from ischemic heart disease and some other diseases was moderately raised (3- to 8-fold), whereas the mortality from malignant disorders was normal. CONCLUSIONS: Cerebrovascular disease was the predominant cause of death among Swedish stroke patients in the 1970s and the 1980s.