Mortality in a Cohort of Street Youth in Montreal

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 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.