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Chronic obstructive pulmonary disease mortality and risk factors were studied in a nationally representative sample of 169,871 Chinese men and women aged 40 years or older. Baseline data were collected in 1991 by using a standard protocol, and a follow-up evaluation was conducted in 1999–2000, with a response rate of 93.4%. Age-standardized mortality (per 100,000 person-years) was 179.9 for men and 141.3 for women. After adjustment for important covariables, the respective relative risks of chronic obstructive pulmonary disease–related mortality for baseline risk factors in men and women were 2.80 (95% confidence interval (CI): 2.64, 2.98) and 2.71 (95% CI: 2.53, 2.89) for each 10-year increase in age, 0.84 (95% CI: 0.74, 0.95) and 1.44 (95% CI: 1.07, 1.95) for alcohol consumption, 1.18 (95% CI: 1.04, 1.35) and 1.77 (95% CI: 1.45, 2.15) for ≥20 pack-years of smoking, 2.37 (95% CI: 1.91, 2.94) and 2.47 (95% CI: 1.66, 3.67) for non-high-school graduation, 1.57 (95% CI: 1.38, 1.79) and 1.35 (95% CI: 1.17, 1.56) for physical inactivity, 2.66 (95% CI: 2.34, 3.02) and 2.60 (95% CI: 2.25, 3.00) for underweight, 1.39 (95% CI: 1.23, 1.57) and 1.73 (95% CI: 1.50, 2.00) for living in northern China, and 2.14 (95% CI: 1.86, 2.46) and 1.79 (95% CI: 1.55, 2.07) for living in rural China. This study indicated that cigarette smoking, low educational level, physical inactivity, and underweight are important modifiable risk factors for chronic obstructive pulmonary disease–related mortality in China. [ABSTRACT FROM AUTHOR]