Objectives: Stroke is one of the leading causes of death worldwide, and the second most lethal cause of death in Taiwan. This study reported the urban and rural difference in prevalence and incidence of stroke in Taiwan. Methods: We used the data of 2000 cohort sample of National Health Insurance to estimate the prevalence and incidence of stroke. Data for information on age, sex, disease status, and urbanization were used in this study. This cohort consists of 200,000 persons of all ages except infants. Cases of stroke were identified according to International Classification of Disease 9th edition (ICD9) for both inpatient and out patients. Results: The crude prevalence and incidence of stroke were 19.8/1,000 and 6.87/1,000, respectively, in 2000. Men had a higher prevalence than women had (20.7/1,000 vs. 18.9/1,000, p=0.003). However, the age-adjusted incidence of stroke was slightly higher in women than in men (6.71/1,000 vs. 6.64/1,000, p=0.23). The results of logistic regression analysis showed that people lived in the least urbanized area were also at higher risk of stroke (OR=1.32, 95%CI=1.22-1.43), compared with those lived in the highest urbanized area. This disparity disappeared in the multivariate logistic regression. Compared with those younger, people had higher risk of stroke incidence were those aged 45-64 (OR=6.9, 95%CI=5.9-8.0), 65-79 (OR=19.2, 95%CI=16.5-22.3), and ≧80 (OR=20.8, 95%CI=19.6-25.7) years. Conclusion: Our findings suggest that there is a high prevalence of stroke in Taiwan in 2000, but no risk differences between males and females, and between urban and rural areas. Age-specific intervention approaches are necessary to halt the incidence of stroke events and associated risk such as hypertension prevention for the elderly.