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Objective: Aim of the paper is to examine the characteristics and the trend of mortality in immigrants in Tuscany in the last decade, and to compare it with that observed in Italians resident in the same region., Design: it is a descriptive study using the data 1997- 2008 of the Regional Mortality Registry of Tuscany., Setting and Participants: Immigrants have been defined those who are resident in Tuscany with non Italian citizenship.They have been classified in immigrants from countries at high migration rates (PFPM) and immigrants from developed countries (PSA)., Main Outcome Measures: Proportional mortality for the period 1997-2008 and trends of standardized (standard: European population) mortality truncated rates (20-64 years) per 100 000 in the period 2002-2008 by citizenship (PFPM, PSA and Italians), gender, age-class and causes of death., Results: In the period 1997-2008, in Tuscany, 4 755 deaths have been registered in immigrants: 3 055 residents (1 782 from PFPM and 1 273 from PSA) and 1 700 not residents. Trends for all and the main causes of death show an increasing gap in mortality between immigrants from PFPM and Italians, with higher rates for Italians.On the contrary infant mortality is higher in children from PFPM and the gap is increasing in the last years. Also the mortality for accidents (1° and 3° cause of death respectively in male and female PFPM) and the mortality for infectious diseases are higher in PFPM immigrants., Conclusion: Mortality study on immigrants in Tuscany highlighted specific health problems of this population deriving from living conditions in the home country as well in the host country. It will be necessary to continue to monitor the mortality trend and characteristics of this population because it represents a good indirect tool to evaluate his socioeconomic integration (considering also his use of our health system), and because this population is still expected to raise in the next decades.