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The August 2003 heat wave in France resulted in many thousands of excess deaths particularly of elderly people. Individual and environmental risk factors for death among the community-dwelling elderly were identified. We conducted a case--control survey and defined cases as people aged 65 years and older who lived at home and died from August 8 through August 13 from causes other than accident, suicide, or surgical complications. Controls were matched with cases for age, sex, and residential area. Interviewers used questionnaires to collect data. Satellite pictures provided profiles of the heat island characteristics around the homes, Lack of mobility was a major risk factor along with some pre-existing medical conditions. Housing characteristics associated with death were lack of thermal insulation and sleeping on the top floor, right under the roof. The temperature around the building was a major risk factor. Behaviour such as dressing lightly and use of cooling techniques and devices were protective factors. These findings suggest people with pre-existing medical conditions were likely to be vulnerable during heat waves and need information on how to adjust daily routines to heat waves. In the long term, building insulation and urban planning must be adapted to provide protection from possible heat waves. [ABSTRACT FROM AUTHOR]