Trends in stroke mortality on an isolated Okinoshima island were studied during a period of 19 years from 1964 through 1982. To calculate the standardized mortality ratio (SMR) and indirect standardized death rate, death certificates of island residents for the observed period were studied. There was a downward trend in stroke mortality on the island. The SMR values indicate that the stroke mortality was lower than the average for Japan. There were significant relationships between the indirect standardized death rate and the percentage of employment in agriculture and fishing and the livelihood protection rate.