Background: Each year in the U.S, 60,000-100,000 people die of venous thromboembolism (VTE), but little is known about mortality and causes of death over the long-term after VTE. Hypotheses: VTE, especially cancer-related VTE, is associated with poor long-term survival. Cancer and circulatory diseases are the main causes of death after VTE. Methods: Atherosclerosis Risk in Communities (ARIC) cohort participants, free of VTE at baseline (n=15,516), were followed (1986-2019) to identify first-time VTE (classified as unprovoked, cancer-provoked, or other-provoked, e.g., after surgery) and deaths. ICD10 codes were used to define cause of death. The proportion who died for each cause of death after first VTE, by type of VTE, was tabulated. Hazard ratios (HRs) of death by type of VTE were estimated with Cox proportional hazards models adjusted for age, race, gender, and pre-baseline cancer. Survival rates were visualized by adjusted survival curves. Results: Over a maximum follow-up of 33 years, 1,076 participants had first-time VTE; 441 were unprovoked, 271 were cancer-provoked, 364 were other-provoked. Mean age at first VTE was 74. After unprovoked VTE, 37% died of circulatory diseases (excluding VTE) and 13% of cancer. Those values were 35% and 13% for other-provoked VTE. By contrast, for cancer-provoked VTE, 80% died of cancer and 10% of circulatory diseases (excluding VTE). In the Figure , those with VTE had poorer long-term survival than 14,400 participants without VTE, and cancer-provoked VTE had the highest mortality. Overall, the HR of death was 2.75 (95% CI: 2.49-3.05) for those with vs without VTE. Those with cancer-provoked VTE had the highest HR, 10.02 (95% CI 8.81-11.40), but those with unprovoked and other-provoked VTE also had higher mortality than those without VTE. Conclusions: In this study, long-term survival after VTE was poor. Apart from cancer-provoked VTE, circulatory diseases were the primary causes of death after VTE. Optimizing cardiovascular prevention could improve long-term survival of patients with VTE.