Deaths from avoidable causes represent the largest component of deaths in young people in Canada and have a considerable social cost in relation to years of potential life lost. We evaluated social and demographic determinants of deaths in youth aged 12–24 years in Nova Scotia for the period 1995–2004. Youth most at risk of death were males, the more socially deprived, and those living in rural areas. There was a five-fold increase in suicides and a three-fold increase in injury deaths in males compared to females and a substantial component of these deaths were amongst males living in rural areas. Initiatives and prevention policies should be targeted towards specific at-risk groups, particularly males living in rural areas. Published vital statistics hide these important trends and thus provide only limited evidence with which to base-prevention initiatives.