Epidemiology of fatalities in Spain due to hornet, wasp and bee stings (Cause Code of Death: X23) is described. Over a 20-year period (1999-2018), a total of 78 fatalities were recorded, mostly occurring in males (85.9%), of 65 years and older (52.6%), at “unspecified places” (67.9%) and in the months of July and August (50%). The X23 mortality rates (X23MR) expressed in terms of annual rates and per million inhabitants, varied from 0.02 to 0.19 (mean value ± standard deviation = 0.09 ± 0.05), placing Spain at low levels in comparison with other countries. A more detailed and specific breakdown of the distribution of the yearly deaths at Sub-state level and across communities reveals some striking features. They were more concentrated in the Communities of Galicia (35.8%), Andalucía (21.7%) and Castilla y León (12.8%). X23MR were estimated in Galicia at 1.82, 1.10 and 2.22 in 2014, 2016 and 2018 respectively; and in Asturias at 1.88 and 0.97, in 2014 and 2017 respectively. The role of the invasive species Vespa velutina (VV), is examined. Due to its habits, abundance and broader distribution, the risk that VV represents to human health is unmatched by other Hymenoptera native species.