The records of 218 poisoning deaths from a Department of Forensic Medicine in a University of China, Tongji Center for Medicolegal Expertise in Hubei (TCMEH), from 1999 to 2008 were retrospectively reviewed. The majority (69.7%) of fatalities was between the ages of 20 and 49 years, and there was a male preponderance (male:female=1.7:1). The most common classes of substances involved in fatalities were rodenticide (19.7%), insecticide and herbicide (17.9%), carbon monoxide (16.5%), drugs (13.8%) and alcohols (12.4%). Ingestion was the predominant route of exposure (65.1%), followed in frequency by inhalation, injection and dermal. In vast majority (64.7%), the manner of death was accidental; suicidal intent was present in 25.2% of cases, homicide in 3.7%, and undetermined 6.4%. When compared to the former reports from the same institution, one for 1956-1984 and another for 1983-1999, an increase was found in the proportion of deaths due to rodenticides, CO, alcohols and drugs, as well as in accidental poisoning deaths. Poisoning deaths due to pesticides remain the major public health problem in China. Further regulatory enforcement should be carried out by government to restrict and manage the use of pesticides and rodenticides which are most toxic to humans.