Occupational exposure to respirable crystalline silica occurs in construction, mining, manufacturing, and other industries and can result in silicosis and other lung diseases. Classic (chronic) silicosis results from exposure to relatively low concentrations of respirable crystalline silica for >10 years. Exposure to higher concentrations of silica for 5-10 years can cause accelerated silicosis, and symptoms of acute silicosis can sometimes develop within weeks of initial exposure to extreme concentrations of silica. Deaths in young adults from acute or accelerated silicosis generally reflect more recent and intense exposures. Silicosis is incurable, but preventable through effective control and elimination of exposure to respirable crystalline silica. To characterize recent trends in premature mortality attributed to silicosis in the United States, CDC analyzed annual mortality data from 1968-2005, the most recent years for which complete data were available. Years of potential life lost before age 65 years (YPLL) and mean YPLL were calculated using standard methodology. During 1968-2005, total annual YPLL attributed to silicosis (17,130) declined 90.2%, from 1,441 (mean per decedent: 7.7 YPLL) to 141 (mean per decedent: 11.8), with an annual average of 8.6 YPLL per decedent for the period. However, the proportion of YPLL attributable to young silicosis decedents increased; an estimated 3,600-7,300 new silicosis cases occur annually. Hazard surveillance, workplace-specific interventions, and further silicosis prevention and elimination efforts, especially among young adults, are needed.