In 1991, 2,169,518 deaths were registered in the United States--21,055 more than in 1990 and the most ever recorded. Despite this increase, the overall age-adjusted death rate was 513.7 per 100,000 population, the lowest ever recorded. Provisional data for 1992 indicate that the death rate continued to decline through 1992. As in previous years, nearly two thirds of deaths in 1991 were caused by the first three leading causes of death (i.e., heart disease, cancer, and stroke). This report summarizes mortality data for 1991 and compares patterns with 1990.