BACKGROUND: For more than three decades, the main health indicators of the rural population of Iran have been gathered using a 'vital horoscope'. In this study, we use information derived from the vital horoscope to assess trends over time and geographic patterns of inequality in these health indicators. METHODS: Nine main health indicators were derived from official annual reports of the Ministry of Health & Medical Education from 1993 to 2005. Having plotted their temporal variations, we modelled their patterns and predicted their values for 2006 and 2007 using linear regression and fractional polynomial regression models. In order to illustrate spatial variations, we normalized the provincial indicators and mapped their geographical variations in two time bands: 1996-2000 and 2001-05. RESULTS: Neonatal mortality rate (NMR), infant mortality rate (IMR) and under-5 mortality rate (U5MR) had a decreasing trend between 1993 and 2005. However, the slop for NMR (beta = -0.26) was much smaller than the slopes for IMR (beta = -1.16) and U5MR (beta = -1.60), thus the rate of decline for NMR was less. The percentage of births attended by unskilled personnel declined from 27.2 to 7.5%, and the maternal mortality rate (MMR) declined from 47 to 34 deaths per 100 000 live births. At a provincial level, the heterogeneity in some indicators decreased (e.g. unskilled attendance at birth, IMR and total fertility rate), while we found no substantial changes in others. CONCLUSION: Our findings indicate a remarkable improvement in most of the health indicators in rural areas. On the other hand, there is still considerable inequality among the rural population at a provincial level. ; Movahedi, Mohammad Hajarizadeh, Behzad Rahimi, Azamdokht Arshinchi, Masoumeh Amirhosseini, Khadijeh Haghdoost, Ali Akbar England Health Policy Plan. 2009 May;24(3):229-37. Epub 2009 Mar 20.