One hundred sixty-seven patients aged 50 years or more had cataracts extracted between Jan 1, 1979, and Dec 31, 1979, at the New England Medical Center, Boston. In comparison with 824 patients who elected one of six other surgical procedures, when data were stratified according to age and sex, patients undergoing cataract extraction had nearly twice the mortality of the reference patients. Analysis indicated diabetic patients did not significantly alter the relative mortality. Our results support the concept that senile cataracts reflect systemic phenomena rather than only local ocular disease.