Background Whether the development of tardive dyskinesia leads to an increase in mortality is still unclear. Aims To explore the relationship between tardive dyskinesia and mortality over a 10-year period, using the National Death Index. Method Death certificates were obtained from the National Death Index on 1621 people repeatedly assessed for tardive dyskinesia by trained raters. Variables with the potential for influencing survival time were also investigated. Results Tardive dyskinesia was significantly associated with an increase in mortality (P<0.001), but this association became non-significant when drug course and age were entered in the regression analysis. Those who had taken only conventional antipsychotics were twice as likely to die compared with those taking atypical agents (P<0.02). For those aged 53-65 years, conventional agents were associated with a sevenfold increase in mortality. Conclusions Older individuals with tardive dyskinesia treated with conventional antipsychotics appear to have a shortened survival time.