Trends and patterns in cerebrovascular disease mortality from 1940 to 1991 are examined using provisional and final mortality data from the US National Vital Statistics System. Trends are analyzed in terms of both period and cohort effects. Monthly data are examined using a time series regression model. Geographic patterns use maps ranking state mortality relative to the US average. Final 1989 data indicate that cerebrovascular disease remains the third leading cause of death in the United States, accounting for 145,551 deaths, or 6.8% of deaths from all causes. The age-adjusted death rate from stroke declined one-third during 1979 to 1989, more rapidly than the other ten leading causes of death. Overall, stroke mortality declined steadily from 1950 through the mid-1970s, then accelerated. On a cohort basis, each successive birth cohort since 1890 has improved their life-span experience from stroke deaths. Maps of stroke mortality demonstrate a persistent "stroke belt" in the South over the past decade.