Demographic features and predisposing factors to fatal food asphyxiation (cafe coronary) were determined by analyzing 141 such fatalities over a 20-year period. Old age, poor dentition, and alcohol consumption were expected findings. Other predisposing factors included institutionalization in long-term medical care facilities, sedative drugs, and natural diseases, most notably parkinsonism. Since institutionalized patients tended to asphyxiate on soft, friable, or snack-like foods, future improvements in rescue techniques should take this into consideration. The incidence of 0.66 per 100,000 population has remained unchanged over the two decades studied. Observers were present at the time of the fatal incident in 85% of the cases. In only a third, the food was lodged ion a supraglottic location. These data indicate that continued efforts toward greater awareness of the cafe coronary syndrome still are needed. Special attention should be directed to the predisposing role of institutionalization, sedative drugs, and natural diseases.