Background.-Prior sailing injury studies have been small, focused investigations. This large, population based study examined the mechanisms and factors contributing to sailboat-related injuries and deaths. Methods.-A retrospective data analysis of the Boating Accident Report Database compiled by the US Coast Guard between 2000 and 2011 was performed. The database was analyzed looking at frequency of events. For each subgroup, proportions were determined and 95% CIs Were calculated. These data, used in conjunction with the 2011 US Coast Guard National Recreational Boating Survey, were used to estimate a fatality rate. Results.-Two hundred seventy-one sailing-related fatalities and 841 injuries were reported. A fatality rate was calculated at 1.19 deaths per million sailing person-days. Weather or hazardous waters were listed as primary contributing factors in 28.0% (95% CI, 22.7-33.4) of deaths; 70.1% (95% CI, 64.7-75.6) of deaths occurred after falling overboard or capsizing. Drowning was the most common cause of death (73.1%; 95% CI, 67.8-78.4), and 81.6% of victims were not wearing a life jacket. Alcohol intoxication contributed to 12.2% (95% CI, 8.3-16.1) of deaths. Operator- or passenger-preventable factors contributed to 52.7% (95% CI, 49.3-56.1) of all injuries; 51.6% (95% CI, 46.1-57.1) of injuries on nonmotorized sailboats were the result of capsizing, and 46.4% (95% CI, 42.1-50.7) of all injuries on motorized sailboats were the result of collisions or grounding. Conclusions.-The calculated fatality rate is similar to that of alpine skiing. Falls overboard and capsizing were the most common fatal accidents. Operator inattention, inexperience, and alcohol use were common preventable factors contributing to fatal and nonfatal injury.