Introduction: This study describes the structure of mortality by cause in French Polynesia (FP) from 2005 to 2010 and its trends from 1984 to 2010. This structure is then compared with that of metropolitan France and the overseas departments (DOM). Methods: The descriptive analysis was conducted using data from medical death certificates, employing mortality indicators. To analyze the temporal evolution of mortality rates, trend tests (Poisson regression model) were performed. Statistical tests of rate differences between geographic areas were also conducted. Results: Over the 2005–2010 period, cardiovascular diseases (age-standardized mortality rate of 163.8 per 100,000), neoplasms (132.6), and external causes of injury (48.3) accounted for 6 out of 10 deaths. Neoplasms were the leading cause of significant premature mortality (46% of deaths before age 65), and violent deaths resulted in the greatest loss of potential years of life (PYOL) (33% of total PYOL). Mortality rates from infectious diseases and cardiovascular diseases decreased significantly between 1984 and 2010 (by an average of -4.5% and -1.8% per year, respectively), while the rate from tumors increased by 0.8% per year. The greatest difference in rates compared to metropolitan France and the French overseas departments is observed for deaths from cardiovascular diseases (a rate 2.3 times higher in the French Polynesia). Conclusion: while the analysis confirmed a downward trend in cause-specific mortality over the past 27 years, the health situation in French Polynesia, compared to France, remains a cause for concern, particularly regarding conditions linked to risky behaviors.