Objective To discuss the cause of death in patients with spinal cord injury from Tangshan earthquake 37 years latter, and compare them with the survey before. Methods The causes of death of the spinal cord injury patients lived in 1 sanatorium and 1 rehabilitation village in Tangshan city, and 6 sanatoriums in villages from 2003 were surveyed. The questionnaire included their general condition, the main cause of death, time of death, age at death, etc., and the findings in 1988 and 2003 were compared. Results Uremia and pressure sore infection were the most major causes of death, in which pressure sore infection was the first cause in the village, and uremia was the first both in the village and city, and the epidemiology of them decreased than before. Cardiovascular disease and cerebrovascular disease were the second and third causes of death respectively. The epidemiology of malignancies increased in this survey, and the longest life time of patients with cervical spinal cord injury was 36 years. Conclusion The top causes of death in spinal cord injury patients from Tangshan earthquakeare uremia, pressure sore infection, cardiovascular disease and cerebrovascular disease. 37 years after Tangshan earthquake, the cause of death and the life expectancy of patients with spinal cord injury have been close to general levels.