To describe the demographic, geographic, and occupational distribution of asbestosis mortality in the United States during 1970–2004, we identified a total of 25,413 asbestosis deaths. We calculated national, state, and county death rates, age-adjusted to the 2000 U.S. standard population. We also calculated industry- and occupation-specific proportionate mortality ratios (PMRs), adjusted for age, sex, and race, and corresponding confidence intervals (CIs) using available data. The overall U.S. age-adjusted asbestosis death rate was 4.1 per million population per year; the rate for males (10.4) was nearly 35-fold higher than that for females (0.3). It increased significantly from 0.6 to 6.9 per million population from 1970 to 2000 (p < 0.001), and then declined to 6.3 in 2004 (p=0.014). High asbestosis death rates occurred predominantly, though not exclusively, in coastal areas. Industries with highest PMRs included ship and boat building and repairing (18.5; 95% CI 16.3–20.9) and miscellaneous nonmetallic mineral and stone products (15.9; 95% CI 13.0–19.5). Occupations with highest PMRs included insulation workers (109.2; 95% CI 93.8–127.2) and boilermakers (21.3; 95% CI 17.0–26.6).