Little information is available about stroke epidemiology in Eastern Europe. The purpose of our study was to determine and compare first‐ever stroke incidence, 30‐day case‐fatality rates, and frequency of some risk factors among stroke patients in four Siberian cities, representing western Siberia, mid‐eastern Siberia, and far eastern Siberia, Russia, during 1987–1988. There were 310 patients with first stroke in Novosibirsk, 447 in Krasnoyarsk, 51 in Tynda, and 24 in Anadyr. Age‐ and sex‐adjusted incidence of stroke was 216.1 per 100,000 residents annually in Novosibirsk, 365.4 in Krasnoyarsk, 324.2 in Tynda, and 347.7 in Anadyr; age‐ and sex‐adjusted 30‐day mortality rates were 31.9, 37.1, 22.3 and 18.3%, respectively. Among the identified patients with stroke, the prevalence of arterial hypertension was highest in Novosibirsk (79%), the prevalence of myocardial infarction and diabetes mellitus was highest in Krasnoyarsk (12 and 11%, respectively), and the prevalence of current smoking was highest in Anadyr (29%) and Tynda (28%). Age‐ and sex‐adjusted stroke incidence rates in Siberia are among the highest in the world. Stroke‐incidence rates tended to increase somewhat from west to east and from south to north across Siberia, although 30‐day mortality rates did not vary much in d