Abstract: Background: A dearth of regional level adult mortality estimates exists in Zambia. Regional adult mortality rates reflect inequalities in socioeconomic conditions and health service provision. Adult mortality rates are useful indicators for monitoring effectiveness and impact of health interventions (HIV/AIDS antiretroviral therapy (ART), tuberculosis (TB) and malaria) at regional level. Previous studies have not produced adult mortality rates at regional level. Data Source and Methods: Using data from the 2010 census, this study estimated adult mortality rates at regional level for age group 15-59 years. Age-specific mortality rates (ASMRs), cause-specific mortality rates (CSMRs), standardised mortality rates (SMRS) and probabilities of dying between age |5 and 60 years (4sq;5) were computed. Correlations with HIV prevalence and literacy rates, and mortality rates were also computed. Findings: Adult mortality rates varied across all provinces. The 4sq;5 was highest for males in Western province, 59 % and lowest in North-western province, 36.7 %. For females, 4sq;5 was highest in Copperbelt province, 47.9 % and lowest in North-western province, 34.8 %. Conclusion: HIV prevalence and literacy rates were positively correlated with regional adult mortality rates. Health policies and programmes aimed at reducing adult mortality should, therefore, be tailored to recognise the regional variations in mortality rates. Keywords: regional-variations, adult mortality, estimation, Zambia, standardised mortality rates