Context 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.
Objectives To estimate mortality rate among street youth in Montreal and to identify
causes of death and factors increasing the risk of death.
Design, Setting, and Population 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.
Main Outcome Measures Mortality rate among participants and factors increasing the risk of
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.