During 2003--2007, deaths occurring in the production of crops and animals in the United States totaled 2,334; of these, 108 (5%) involved cattle as either the primary or secondary cause (1). During the same period, Iowa, Kansas, Missouri, and Nebraska accounted for 16% of the nation's approximately 985,000 cattle operations and 21% of the nation's cattle and calf herd (2). To better characterize cattle-caused deaths in these four states, investigators reviewed all such deaths occurring during the period 2003--2008 that were detected by two surveillance programs, the Iowa Fatality Assessment and Control Evaluation (IA FACE) and the Great Plains Center for Agricultural Health (GPCAH). This report summarizes that investigation, which identified 21 cattle-related deaths. These deaths occurred throughout the year, and decedents tended to be older (aged =60 years) (67%) and male (95%). Except in one case, the cause of death was blunt force trauma to the head or chest. Circumstances associated with these deaths included working with cattle in enclosed areas (33%), moving or herding cattle (24%), loading (14%), and feeding (14%). One third of the deaths were caused by animals that had previously exhibited aggressive behavior. To reduce the risk for death from cattle-caused injuries, farmers and ranchers should be aware of and follow recommended practices for safe livestock-handling facilities and proper precautions for working with cattle, especially cattle that have exhibited aggressiveness. Data gathering and analysis were performed collaboratively by IA FACE (operated by the University of Iowa on behalf of the Iowa Department of Public Health) and GPCAH (part of the University of Iowa's College of Public Health). Both programs are funded by CDC and collect surveillance data on agricultural deaths.* IA FACE collects basic information on all traumatic occupational fatalities in Iowa as identified primarily through multisource surveillance of the media, including newspapers, radio, television, and the Internet. Once alerted to a potential occupational death, IA FACE requests reports from investigating authorities such as the local police and sheriff's departments, emergency medical services, and the medical examiner. GPCAH surveillance is based solely on reports from Iowa, Kansas, Missouri, and Nebraska newspapers and other periodicals. Since 2003, GPCAH has been building a press report database, which includes descriptive information about the victim, event, circumstances, and nature of the injuries in fatal and nonfatal farm and agricultural injury events within the four states. In this analysis, cases were defined as occupational fatalities caused by cattle that occurred in Iowa, Kansas, Missouri, or Nebraska during 2003--2008. Fatalities that occurred when motor vehicles crashed into cattle on roadways (such as while cattle were being herded with an all-terrain vehicle or pickup truck in a pasture) were excluded.