Analysis of death certification in North Carolina for a three-year period, 1969 through 1971, showed regional differences in mortality rates from stroke in white men, with the highest rates in the Plains (tobacco growing and farming) area and the lowest rates in the Mountain region. These geographic differences in death rates were observed in all but the youngest age decade and also in the various types of stroke, i.e., hemorrhagic and occlusive cerebrovascular diseases. This regional variation in mortality, however, was not present in white women or blacks. The prevalence at death of heart disease, hypertension and diabetes also was higher in the Plains than in the Mountain region, suggesting that the observed geographic variation of stroke mortality is related to one or more of these major risk factors. It is concluded that the geographic differences in stroke mortality, which had been reported during previous decades, are real and are not due to variations in death certification, errors in diagnosis, or other explanations that might artificially produce inaccuracies in vital statistics.