West Nile virus (WNV) outbreak in North Dakota in 2002 included over 569 horse cases, clustered mainly in the eastern and northeastern parts of the state. The pattern of occurrence observed suggested existence of specific environmental and ecological factors that increased the risk for infection and illness in those locations. We developed a predictive model with factors that explained the pattern of WNV occurrence observed. Results indicated that surface elevation, temperature, precipitation, reported WNV-positive birds, reported WNV-positive humans, and reported WNV-positive mosquitoes were important predictors of occurrence in horses. However, case distance from water bodies was not significant in the model. Future predictive models of WNV occurrence in horses should take into account these factors in order to improve accuracy and reliability. Research into other potential determinants such as horse management factors are required to determine more differential risk factors associated with WNV occurrence in horses.