OBJECTIVES: To estimate excess mortality during heat waves and cold spells, and to identify vulnerable population groups by age and cause of death. METHODS: Daily mortality in Moscow, Russia from all non-accidental, cardiovascular and respiratory causes between January 2000 and February 2006 was analysed. Mortality and displaced mortality during cold spells and heat waves were estimated using independent samples t tests. RESULTS: Cumulative excess non-accidental mortality during the 2001 heat wave was 33% (95% CI 20% to 46%), or approximately 1200 additional deaths, with short-term displaced mortality contributing about 10% of these. Mortality from coronary heart disease increased by 32% (95% CI 16% to 48%), cerebrovascular mortality by 51% (95% CI 29% to 73%) and respiratory mortality by 80% (95% CI 57% to 101%). In the 75+ age group, corresponding mortality increments were consistently higher except respiratory deaths. An estimated 560 extra deaths were observed during the three heat waves of 2002, when non-accidental mortality increased by 8.5%, 7.8% and 6.1%, respectively. About 40% of these deaths were brought forward by only a few days, bringing net mortality change down to 3.2% (95% CI 0.8% to 5.5%). The cumulative effects of the two cold spells in 2006 on mortality were significant only in the 75+ age group, for which average daily mortality from all non-accidental causes increased by 9.9% (95% CI 8.0% to 12%) and 8.9% (95% CI 6.7% to 11%), resulting in 370 extra deaths; there were also significant increases in coronary disease mortality and cerebrovascular mortality. CONCLUSIONS: This study confirms that daily mortality in Moscow increases during heat waves and cold spells. A considerable proportion of excess deaths during heat waves occur a short time earlier than they would otherwise have done. Harvesting, or short-term mortality displacement, may be less significant for longer periods of sustained heat stress.