Objective <p>While the five leading causes of death in Texas mirror national trends, the unique racial/ethnic and geographical diversity of the state requires a focused analysis of mortality disparities. To address this gap, we conducted a scoping review of Texas-specific peer-reviewed studies on how race/ethnicity and rurality impact mortality from heart disease, cancer, unintentional injuries, stroke, and chronic lower respiratory diseases (CLRDs).</p> Methods <p>Using a scoping review methodology, we identified Texas-specific empirical articles examining the relationship between either rurality or race/ethnicity and the leading causes of death. We extracted and analyzed data from the included studies using a coding instrument specifically designed for this study. Descriptive synthesis summarized study trends, and multivariable logistic regression assessed overarching patterns.</p> Results <p>Our synthesis of the Texas-specific literature reveals that cancer was the focus of nearly half of the studies (49.4%), whereas rurality was seldom examined (4.2%). Multivariable logistic regression showed that studies on CLRDs were more likely to find higher mortality among Blacks (<i>OR</i> = 3.07) and Hispanics (<i>OR</i> = 4.24). For stroke, Hispanics were associated with increased mortality (<i>OR</i> = 2.49), while for unintentional injuries, the study found significantly higher mortality for Native Americans (<i>OR</i> = 8.72) and Blacks (<i>OR</i> = 2.76).</p> Conclusions <p>Existing Texas-focused studies consistently link racial and ethnic minority status with higher mortality from the five leading causes of death. However, significant gaps remain, particularly concerning the intersection of race/ethnicity and rurality. Future Texas-based research should prioritize these intersectional factors to better understand and address persistent mortality disparities.</p>