OBJECTIVETo confirm the existence of an increased risk of complications from influenza A (H1N1)p among patients with diabetes.RESEARCH DESIGN AND METHODSUsing data from an enhanced influenza surveillance project in Montreal, Canada, and age/sex-specific population estimates of diabetes prevalence, we estimated the risk of hospitalization among persons with diabetes. Comparing hospitalized patients admitted or not to an intensive care unit (ICU), we estimated the risk of ICU admission associated with diabetes, controlling for other patient characteristics.RESULTSAmong 239 hospitalized patients with PCR-confirmed influenza A (H1N1)p, 162 (68%) were interviewed, of whom 22 had diabetes, when 7.1 were expected (prevalence ratio 3.10 [95% CI 2.04–4.71]). The odds ratio for ICU admission was 4.29 (95% CI 1.29–14.3) among hospitalized patients with diabetes compared to those without.CONCLUSIONSDiabetes triples the risk of hospitalization after influenza A (H1N1)p and quadruples the risk of ICU admission once hospitalized.

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 street youth 14 to 25 years of age were recruited in a prospective cohort with semiannual 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 Qué bec. Main Outcome MeasuresMortality 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 100000 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.

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Summary Background People who inject drugs (PWID) are at increased risk for HIV and hepatitis C virus (HCV) infection and also have high levels of homelessness and unstable housing. We assessed whether homelessness or unstable housing is associated with an increased risk of HIV or HCV acquisition among PWID compared with PWID who are not homeless or are stably housed. Methods In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies published between Jan 1, 2000, and June 13, 2017. Using the same strategy as for this existing database, we searched MEDLINE, Embase, and PsycINFO for studies, including conference abstracts, published between June 13, 2017, and Sept 14, 2020, that estimated HIV or HCV incidence, or both, among community-recruited PWID. We only included studies reporting original results without restrictions to study design or language. We contacted authors of studies that reported HIV or HCV incidence, or both, but did not report on an association with homelessness or unstable housing, to request crude data and, where possible, adjusted effect estimates. We extracted effect estimates and pooled data using random-effects meta-analyses to quantify the associations between recent (current or within the past year) homelessness or unstable housing compared with not recent homelessness or unstable housing, and risk of HIV or HCV acquisition. We assessed risk of bias using the Newcastle-Ottawa Scale and between-study heterogeneity using the I 2 statistic and p value for heterogeneity. Findings We identified 14 351 references in our database search, of which 392 were subjected to full-text review alongside 277 studies from our existing database. Of these studies, 55 studies met inclusion criteria. We contacted the authors of 227 studies that reported HIV or HCV incidence in PWID but did not report association with the exposure of interest and obtained 48 unpublished estimates from 21 studies. After removal of duplicate data, we included 37 studies with 70 estimates (26 for HIV; 44 for HCV). Studies originated from 16 countries including in North America, Europe, Australia, east Africa, and Asia. Pooling unadjusted estimates, recent homelessness or unstable housing was associated with an increased risk of acquiring HIV (crude relative risk [cRR] 1·55 [95% CI 1·23–1·95; p=0·0002]; I 2 = 62·7%; n=17) and HCV (1·65 [1·44–1·90; p<0·0001]; I 2 = 44·8%; n=28]) among PWID compared with those who were not homeless or were stably housed. Associations for both HIV and HCV persisted when pooling adjusted estimates (adjusted relative risk for HIV: 1·39 [95% CI 1·06–1·84; p=0·019]; I 2 = 65·5%; n=9; and for HCV: 1·64 [1·43–1·89; p<0·0001]; I 2 = 9·6%; n=14). For risk of HIV acquisition, the association for unstable housing (cRR 1·82 [1·13–2·95; p=0·014...