ORIGINAL ARTICLE Causes of death among undocumented migrants in Sweden, 1997  2010 Anna Wahlberg*, Carina Ka ¨ llesta ˚ l, AnnaCarin Lundgren and Birgitta Esse ´n Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden Background: Undocumented migrants are one of the most vulnerable groups in Swedish society, where they generally suffer from poor health and limited health care access. Due to their irregular status, such migrants are an under-researched group and are not included in the country’s Cause of Death Register (CDR). Objective: To determine the causes of death among undocumented migrants in Sweden and to ascertain whether there are patterns in causes of death that differ between residents and undocumented migrants. Design: This is a cross-sectional study of death certificates issued from 1997 to 2010 but never included in the CDR from which we established our study sample of undocumented migrants. As age adjustments could not be performed due to lack of data, comparisons between residents and undocumented migrants were made at specific age intervals, based on the study sample’s mean age at death9a half standard deviation. Results: Out of 7,925 individuals surveyed, 860 were classified as likely to have beenundocumented migrants. External causes (49.8%) were the most frequent cause of death, followed by circulatory system diseases, and then neoplasms. Undocumented migrants had a statistically significant increased risk of dying from external causes (odds ratio [OR] 3.57, 95% confidence interval [CI]: 2.834.52) and circulatory system diseases (OR 2.20, 95% CI: 1.732.82) compared to residents, and a lower risk of dying from neoplasms (OR 0.07, 95% CI: 0.040.14). Conclusions: We believe our study is the first to determine national figures on causes of death of undocumented migrants. We found inequity in health as substantial differences in causes of death between undocumented migrants and residents were seen. Legal ambiguities regarding health care provision must be addressed if equity in health is to be achieved in a country otherwise known for its universal health coverage. Keywords: cause of death register; ICD-10; irregular migrants; death certificate; health care access Responsible Editor: Peter Byass, Umea ˚ University, Sweden. *Correspondence to: Anna Wahlberg, Department of Women’s and Children’s Health, IMCH, Uppsala University, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden, Email: anna.wahlberg@kbh.uu.se Received: 27 March 2014; Revised: 8 May 2014; Accepted: 10 May 2014; Published: 3 June 2014 E stimates of undocumented migrants in the European Union (EU) range from 1.9 to 3.8 million. Indica- tions of a declining number are thought to be a result of the EU’s growth and its legalization programs (1). The corresponding figure for Sweden is estimated at 10,00050,000, of which 2,0003,000 are believed to be children (2). ‘Irregular migrants’, ‘unauthorized migrants’, ‘illegal migrants’, and ‘illegal aliens’ are all terms used to describe this group of people. We have chosen ‘undocu- mented migrants’, and defined it as follows: individuals who have entered the country illegally and never claimed asylum; asylum seekers who have been rejected and gone underground to avoid deportation; those who have over- stayed their visa or work permit; EU citizens who are not compliant with regulations governing the right to residence (3). Insecure working and living conditions among undo- cumented migrants are associated with psychological issues and somatic symptoms (4). Poor access to health care is one of the main issues for undocumented migrants. Its outcome is deteriorating health. Several barriers to health care access have been identified: absence of legal entitlements to health care, poor knowledge of a person’s right to health care, lack of financial resources, fear of Global Health Action æ Global Health Action 2014. # 2014 Anna Wahlberg et al. This is an Open Access article distributed under the terms of the Creative Commons CC-BY 4.0 License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license. 1 Citation: Glob Health Action 2014, 7: 24464 - http://dx.doi.org/10.3402/gha.v7.24464 (page number not for citation purpose)