Introduction. Studying demographic indicators of certain territories is necessary for assessing the population health, territorial trends in birth and mortality rates, and factors contributing to demographic processes; it also facilitates the development of regional programmes for improving a medical and demographic situation based on specific needs. The aim was to study the trends in demographic indicators in the Sakha Republic (Yakutia) for the period 1990-2020. Materials and Methods. We performed a retrospective comparative analysis of corresponding indicators for the Russian Federation, the Far Eastern Federal District, and the Sakha Republic (Yakutia) using the data from the Rosstat Federal State Statistics Service for 1990-2020. Results and Discussion. It was established that during the entire period under review, the Sakha Republic (Yakutia) had been maintaining natural population increase due to the high birth rate and relatively low mortality rates. However, the trends demonstrated decreasing birth and natural increase rates alongside an increasing migration growth. A special attention was given to the mortality from external causes, characterized by the highest degree of preventability. It was revealed that despite a significant decrease in the indicator during the studied period (by 25.0% from 164.6 to 123.4 per 100,000 population), the mortality rate from external causes in the Sakha Republic (Yakutia) was higher than the Russian Federation average (in 2020 – by 22.7%; 123.4 and 95.3 per 100,000 population, respectively). The Sakha Republic(Yakutia) had a high suicide rate (20.5 per 100,000 population), which was 44.9% higher than that of the Russian Federation (11.3 per 100,000 population), and by 12.2% - of the Far Eastern Federal District (18.0 per 100,000 population). A mortality rate in children aged 0-17 years was characterized by a significant contribution of accidental drowning deaths, which accounted for 12.7 - 32.1% of the total number of deaths in children of this age category in 2016-2020 (in 2020 – 22.5%). Conclusion. The current medical and demographic situation in the Sakha Republic (Yakutia) is characterized by a decreasing trend in the birth and mortality rates, positive natural increase and migration growth trends. Over the period in study, the birth rate decreased by 31.6%; natural increase – by 67.7%; total deaths – by 25.0%, and from external causes – by 6.8%. The structure of external causes maintained an unfavourable situation with violent deaths in adults, and accidental drownings in children and adolescents. It is obvious that the potential for future decrease in the mortality rate lies in a decreasing number of deaths from preventable causes, including external ones.