We sought to describe the fatalities to occupants of pickup truck cargo areas and to compare the mortality of cargo area occupants to passengers in the cab. From the Fatality Analysis Reporting System (FARS) files for 1987-1996, we identified occupants of pickup trucks with at least one fatality and at least one passenger in the cargo area. Outcomes of cargo area occupants and passengers in the cab were compared using estimating equations conditional on the crash and vehicle. Thirty-four percent of deaths to cargo occupants were in noncrash events without vehicle deformation. Fifty-five percent of those who died were age 15-29 years and 79% were male. The fatality risk ratio (FRR) comparing cargo area occupants to front seat occupants was 3.0 (95% Confidence Interval [CI] = 2.7-3.4). The risk was 7.9 (95% CI = 6.2-10.1) times that of restrained front seat occupants. The FRR ranged from 92 (95% CI = 47-179) in noncrash events to 1.7 (95% CI = 1.5-1.9) in crashes with severe vehicle deformation. The FRR was 1.8 (95% CI = 1.4-2.3) for occupants of enclosed cargo areas and 3.5 (95% CI = 3.1-4.0) for occupants of open cargo areas. We conclude that passengers in cargo areas of pickup trucks have a higher risk of death than front seat occupants, especially in noncrash events, and that camper shells offer only limited protection for cargo area occupants.