title: Unstable housing and hepatitis C incidence among injection drug users in a Canadian setting.
abstract: BACKGROUND
  There has emerged growing recognition of the link between housing and health. Since Vancouver, Canada has had increasing concerns with homelessness brought about by urban renewal in the lead-up to the 2010 Winter Olympic Games, we evaluated hepatitis C virus (HCV) incidence among injection drug users (IDU) with and without stable housing.
  
  
  METHODS
  Data were derived from a collaboration between two prospective cohort studies of IDU in Vancouver, Canada. Using Cox Proportional Hazards regression, we compared HCV incidence among participants with and without stable housing, and determined independent predictors of HCV incidence.
  
  
  RESULTS
  Overall, 3074 individuals were recruited between May 1996 and July 2007, among whom 2541 (82.7%) were baseline HCV-infected. Among the 533 (17.3%) individuals who were not HCV-infected at baseline, 147 tested HCV antibody-positive during follow-up, for an incidence density of 16.89 (95% confidence interval: 14.76 - 19.32) per 100 person-years. In a multivariate Cox regression model, unstable housing remained independently associated with HCV infection (relative hazard = 1.47 (1.02 - 2.13).
  
  
  CONCLUSIONS
  HCV prevalence and incidence are high in this setting and were associated with unstable housing. Efforts to protect existing low-income housing and improve access to housing may help to reduce HCV incidence.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada. christinakim3@gmail.com
authors.forename: Christina
authors.initials: C
authors.lastname: Kim
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Kathy
authors.initials: K
authors.lastname: Li
authors.forename: Ruth
authors.initials: R
authors.lastname: Zhang
authors.forename: Mark W
authors.initials: MW
authors.lastname: Tyndall
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology*; D006798:Housing; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*