The coalfield in the Hunter Region, Australia, has been reported to have a high incidence of ischemic heart disease. The purpose of the study was to determine the hospitalized stroke attack rates in rural, urban, and coalfield areas in the Hunter Region. All the stroke events across the Hunter Region (population 521,785) between July 1995 and June 2000 were included. The annual age and sex specific stroke attack rates and 28-day and 12-month case-fatalities were evaluated. The trends of attack rates during the study period in the region were examined by Poisson regression. The crude annual stroke attack rate was 178/100,000 population, with 95% confidence interval (CI) 164 to 192. The coalfields showed a significantly higher attack rates in comparison to the other two areas (P = .006, respectively). The attack rates in the whole region and the three individual areas were stable. The 28-day and 12-month case-fatalities for stroke were 19% (95% CI, 17-22%) and 30% (95% CI, 28-31%) respectively and showed a non-significant decrease in the main study periods. The higher stroke attack rates in the coalfields suggest future prospective studies are necessary in identifying the underlying risk factors