Purpose <p>This study aimed to assess the associations between serum concentrations of copper, zinc and selenium, and pneumonia death risk.</p> Methods <p>Study included 2088 men from the Kuopio Ischaemic Heart Disease Risk Factor Study aged 42–60 years. Pneumonia deaths were collected by computer linkage to the national Causes of Death Register. Cox proportional hazards regression models, adjusted for multiple variables, were used for analysis.</p> Results <p>During a mean follow-up of 21.7 years (SD 7.5 years), 139 pneumonia deaths occurred. The multivariable-adjusted hazard ratio for pneumonia death in the highest serum copper-to-zinc-ratio and copper concentration tertiles were 1.75 (95% CI: 1.13–2.71) and 1.64 (95% CI: 1.08–2.50), respectively. Serum zinc concentration showed a statistically significant association with pneumonia death, with the lowest risk observed in the second tertile and no further decrease in risk in the highest tertile. Serum copper-to-selenium ratio nor selenium concentrations were associated with pneumonia death risk.</p> Conclusions <p>Our findings suggest that a higher serum copper-to-zinc-ratio and higher serum copper concentration are associated with increased risk of pneumonia death, while a higher serum zinc concentration is linked to a decreased risk of pneumonia death in middle-aged and older men.</p>