BACKGROUND: Differences in mortality by country of birth in England and Wales in people under 70 years of age have been demonstrated previously. Changes in age distribution of migrants and in migration patterns have occurred subsequently. METHODS: All-cause and circulatory disease mortality for people aged 20 years and over in England and Wales by country of birth were examined using population data from the 2001 Census and mortality data for 2001-2003. Indirect standardization was used to estimate sex-specific standardized mortality ratios (SMRs) and 95% confidence intervals (CI) in comparison to mortality for England and Wales as a whole. RESULTS: SMRs for all-cause mortality were statistically significantly higher than the national average for people born in Ireland, Scotland, East Africa and West Africa and lower for people born in China and Hong Kong. SMRs for circulatory disease were highest among people born in Bangladesh and lowest among people born in China and Hong Kong. Patterns of ischaemic heart disease and cerebrovascular disease mortality differed by country of birth. CONCLUSIONS: Mortality, particularly due to ischaemic heart disease and stroke, differs markedly by country of birth in all age groups including the > or =70-year-old group.