Background Whether immigrant children receive unnecessary treatments and surgical procedures to a greater extent than non-immigrants remains controversial.

Objective To investigate whether hospitalisation rates differ between immigrant and non-immigrant preschool children and the extent to which such differences relate to specific pathological conditions.

Methods All discharges occurring to children aged 1–5 years between 2005 and 2007 in the Italian Region of Veneto (4.8 million inhabitants) were analysed by diagnosis related groups (DRGs). Crude and age-standardised hospitalisation RRs of immigrant versus Italian children were computed.

Results Hospitalisation rates for medical conditions were similar between immigrant and Italian children. However, hospitalisation rates among immigrant children were significantly lower than those among Italians for all the most frequent surgical DRGs. RRs (95% CI) of immigrant versus Italian children were 0.46 (0.41 to 0.51) for tonsillectomy/adenoidectomy and 0.46 (0.38 to 0.57) for testes procedures in boys; 0.44 (0.38 to 0.49) for tonsillectomy/adenoidectomy and 0.47 (0.34 to 0.65) for extraocular procedures in girls. Only circumcision procedures were more frequent (fourfold excess) among immigrants.

Conclusion Hospitalisation rates for the most frequent surgical procedures are significantly lower among immigrants compared to non-immigrant preschool children. Reduced surgery rates among immigrants might result from a complex interplay between parental attitudes and knowledge of paediatric conditions, language barriers and access to primary care.