Exposure to disasters and other extreme events is rising across the globe but the impact on long-term mortality risks of affected populations is not established. We examine how mortality and individual-specific traumatic exposures at the time of the disaster affect mortality risks of survivors over the next ten years, using data from Aceh, Indonesia collected before and after the 2004 Indian Ocean Tsunami. Across communities, the higher the percentage of individuals killed in the tsunami, the lower the mortality rate for adults over the next decade. However, among older adults post-disaster mortality is elevated for males with poor post-tsunami psychosocial health and for females whose spouse died in the tsunami. Individual-specific tsunami exposures do not affect mortality of younger adults within the 10 year time frame. Whereas positive mortality selection is evident for all adults, scarring is evident only for older adults and is large enough to substantively counteract the reductions in risk from positive mortality selection.