Mortality in a cohort of street youth in Montreal.
BACKGROUND
Many studies have shown a high prevalence of sexually transmitted diseases, human immunodeficiency virus (HIV) infection, viral hepatitis, drug dependence, and mental health problems among street youth. However, data on mortality among these youth are sparse.


OBJECTIVE
To estimate mortality rate among street youth in Montreal and to identify causes of death and factors increasing the risk of death.


METHODS
From January 1995 to September 2000, 1013 street youth 14 to 25 years of age were recruited in a prospective cohort with semi-annual follow-ups. Original study objectives were to determine the incidence and risk factors for HIV infection in that population; however, several participants died during the first months of follow-up, prompting investigators to add mortality to the study objectives. Mortality data were obtained from the coroner's office and the Institut de la Statistique du Québec.


METHODS
Mortality rate among participants and factors increasing the risk of death.


RESULTS
Twenty-six youth died during follow-up for a mortality rate of 921 per 100 000 person-years (95% confidence interval [CI], 602-1350); this represented a standardized mortality ratio of 11.4. The observed causes of death were as follows: suicide (13), overdose (8), unintentional injury (2), fulminant hepatitis A (1), heart disease (1); 1 was unidentified. In multivariate Cox regression analyses, HIV infection (adjusted hazard ratio [AHR] = 5.6; 95% CI, 1.9-16.8), daily alcohol use in the last month (AHR = 3.2; 95% CI, 1.3-7.7), homelessness in the last 6 months (AHR = 3.0; 95% CI, 1.1-7.6), drug injection in the last 6 months (AHR = 2.7; 95% CI, 1.2-6.2), and male sex (AHR = 2.6; 95% CI, 0.9-7.7) were identified as independent predictors of mortality.


CONCLUSIONS
Current heavy substance use and homelessness were factors associated with death among street youth. HIV infection was also identified as an important predictor of mortality; however, its role remains to be clarified. These findings should be taken into account when developing interventions to prevent mortality among street youth.
Direction de Santé Publique de Montréal, Montreal, Quebec. eroy@santepub-mtl.qc.ca
Elise
E
Roy
Nancy
N
Haley
Pascale
P
Leclerc
Barbara
B
Sochanski
Jean-François
JF
Boudreau
Jean-François
JF
Boivin
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D005260:Female; D018453:Homeless Youth / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality / Q000639:trends*; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors; D014505:Urban Population / Q000706:statistics & numerical data