OBJECTIVES: The aim of this study was to analyze the characteristics of accident and emergency department (A and E) access, process management and outcome after grouping patients by their citizenship. METHODS: The study was conducted using the recorded linkage database at a local public health agency in north-east Italy. We investigated 35,541 adult patients (18-65 years) accessing the A and E. RESULTS: An underutilization of primary care services and the use of A and E for nonurgent conditions is a problem affecting all nationalities, natives included. The length of the stay in A and E and the consistency between level of urgency and priority of the visits at entry and exit triage were similar for all citizenship groups. Illegal migrants were more frequently hospitalized after A and E visits than other groups. CONCLUSIONS: The potentially inappropriate use of A and E for non-urgent conditions was common among all the patient groups considered and barriers to primary care may enhance this behavior among migrants. This situation could also explain the higher odds ratio for migrants' hospitalization and discharge to ambulatory services after A and E visits.