A study of 9,135 persons injured between 1973 and 1984 and treated at any of 13 regional spinal cord injury care systems was conducted to compare their age-, sex-, race-, and cause-specific mortality rates with those of the general population. All subjects survived at least 24 hours. Follow-up was terminated in December, 1985 when 854 persons (9.3%) had died. Although many persons had multiple causes of death, the leading primary causes were pneumonia, nonischemic heart disease, septicemia, symptoms and ill-defined conditions, pulmonary emboli, and ischemic heart disease. During the study period, spinal cord injured persons were 82.2 times more likely to die of septicemia, 46.9 times more likely to die of pulmonary emboli, and 37.1 times more likely to die of pneumonia than comparable individuals from the general population. Though some cause-specific mortality rates for spinal cord injured persons have declined dramatically, many remain substantially above normal. Before life expectancies increase further, improved methods for preventing and managing these fatal complications must be developed.