Background Injuries are a major public health problem worldwide, being the leading cause of death in children and adolescents in developed countries. However, knowledge on recent secular trends in injury deaths of adolescents is sparse.

Methods Using Official Cause-of-Death Statistics of Finland, we examined the nationwide trends in the age- and sex-specific incidence rates of fatal injuries among 10–14-year-old and 15–19-year-old adolescents in Finland between 1971 and 2013.

Results The incidence rate of fatal injuries decreased considerably in both age groups during the 43-year follow-up period. The decline in injury deaths was mainly due to decreased deaths in traffic accidents. The number of drownings reached the ultimate goal—that is, there were no drownings in Finnish 10–19-year-old adolescents in 2013. The rates of intentional injury deaths remained stable in girls, while in 15–19-year-old boys a decreasing trend was evident. During the deep economic depression in 1990, the incidence of suicide in 15–19-year-old boys was as high as 40.1. At that time, boys’ suicide risk was 7.4 times higher than that of girls. Since then, boys’ risk for suicide has clearly decreased and was 1.6 times higher than the corresponding risk in girls in 2013.

Conclusions The incidence rate of fatal injuries decreased considerably in Finnish adolescents during the period 1971–2013. The clearest change occurred in road traffic injuries and drownings. The rates of intentional injury deaths remained unaltered in girls while 15–19-year-old boys showed a decreasing trend.