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Objective The objective of the current study was to investigate the environmental factors associated with fall injuries among elderly people. Population and methods We used data from the Norwegian Injury Sample Register, a prospective ongoing registration system of injuries that occur in the defined population of four cities in Norway. For this study we selected information about all fall-related injuries that had occurred among people aged 65 years and older from 1990 to 1997, a total of 10,696 cases. Results Loss of balance was the most common cause of injury (35%), followed by slipping (21%), and stumbling (16%). The following environmental factors were involved in occurrence of injuries: indoor stairs (7%), doorstep (1%), ladders (1%), floor carpets (2%), bathroom floor (2%), loose cables (<1%), bathtub/shower (<1%), floor indoors 16%, icy outdoor surface 13%, other specified factors 40%, unknown (19%). There have been significant variations in environmental factors associated with occurrence of injury by age and nature of injury. Conclusions Commonly targeted home hazards account for a small fraction of injuries. Improvements in home safety are unlikely to result in significant gains in preventing fall injuries among elderly people. Icy outdoor surfaces represent a significant health hazard and a possible target for fall prevention measures.