A review was undertaken of the demographics, geographic distribution, occupational patterns, and temporal trends of silicosis mortality in the United States from 1968 to 1990. Data on silicosis mortality were obtained from the National Center for Health Statistics (NCHS) computer records on causes of death. Information was compiled for annual silicosis death counts, distribution by age, race, and sex, annual crude silicosis mortality, and age adjusted silicosis mortality rate. Silicosis was found to be associated with 13,744 deaths from 1968 to 1990, and was the specific cause of death in 46% of these cases. Males suffered 98% of the silicosis deaths reported in the study period and had a mean age at death of 71.5 years. Eighty eight percent of the silicosis victims were white. The number of silicosis deaths dropped from 1,157 in 1968 to 308 in 1990. Both the annual crude and age adjusted silicosis mortality rates leveled off beginning in the early 1980s. The highest incidences of silicosis mortalities were recorded in Pennsylvania, Ohio, California, New York, West Virginia, Michigan, New Jersey, Colorado, Wisconsin, Illinois, Virginia, and Florida. Construction, metal mining, blast furnace work, steelworks, finishing mills, mineral and stone work, and coal mining were the occupations most closely associated with silicosis mortality. The authors conclude that new prevention strategies should be investigated, with particular attention given to sources of silica (14808607) exposures.