OBJECTIVES: Meningococcal disease (MD), is a leading cause of meningitis in the U.S. The purpose of this study was to determine the epidemiology of MD in Oklahoma, including trends, high-risk populations, and outcomes. METHODS: Cases from the statewide passive reporting system with disease onset between 1988 and 2004 were included; 2002-2004 cases were linked to hospital discharge data. We performed a multivariate logistic regression of variables predicting death. RESULTS: There were 545 total cases (mean annual incidence rate 1.0/100,000); 13% died. Rates were highest for children younger than 2 years of age; black males had rates two times higher than the state rate and a different age distribution than other race-gender groups. Mean length of hospital stay was 12 days and mean charges were $37,724. For every 10 years of age, the risk of death increased 13% (adjusted odds ratio 1.13, 95% confidence interval [CI] 1.05, 1.22). People younger than age 40 who developed MD between October and February were 68% more likely to die than those who developed it in other months (rate ratio [RR] 1.68, 95% CI 1.39, 2.05); an increased risk of death during these months was not statistically significant in people aged 40 and older (RR 1.19, 95% CI 0.83, 1.69). CONCLUSION: Using statewide public health surveillance data to characterize the epidemiology of MD is important to understand local trends and risk factors.