Global COVID-19 case fatality rates influenced by inequalities in human development and vaccination rates.

Aim: COVID-19 has exerted distress on virtually every aspect of human life with disproportionate mortality burdens on older individuals and those with underlying medical conditions. Variations in COVID-19 incidence and case fatality rates (CFRs) across countries have incited a growing research interest regarding the effect of social factors on COVID-19 case-loads and fatality rates. We investigated the effect of population median age, inequalities in human development, healthcare capacity, and pandemic mitigation indicators on country-specific COVID-19 CFRs across countries and regions. Subject and methods: Using population secondary data from multiple sources, we conducted a cross-sectional study and used regional analysis to compare regional differences in COVID-19 CFRs as influenced by the selected indicators. Results: The analysis revealed wide variations in COVID-19 CFRs and the selected indicators across countries and regions. Mean CFR was highest for South America at 1.973% (± 0.742) and lowest for Oceania at 0.264% (± 0.107), while the Africa sub-region recorded the lowest scores for pandemic preparedness, vaccination rate, and other indicators. Population Median Age [0.073 (0.033 0.113)], Vaccination Rate [-3.3389 (-5.570.033 -1.208)], and Inequality-Adjusted Human Development Index (IHDI) [-0.014 (-0.023 -0.004)] emerged as statistically significant predictors of COVID-19 CFR, with directions indicating increasing Population Median Age, higher inequalities in human development and low vaccination rate are predictive of higher fatalities from COVID-19. Conclusion: Regional differences in COVID-19 CFR may be influenced by underlying differences in sociodemographic and pandemic mitigation indicators. Populations with wide social inequalities, increased population Median Age and low vaccination rates are more likely to suffer higher fatalities from COVID-19.

Factors associated with counselling adherence in opioid treatment programs.

Federally certified opioid treatment programs (OTPs) provide psychosocial counselling in addition to medications for opioid use disorder (MOUDs) using a patient-centered approach in providing substance use disorder treatment. This study explored factors associated with patients' adherence to counselling while receiving MOUD at an OTP. A retrospective cohort design using data on adult patients (n = 1151, 61% females, 39% males) admitted to an OTP from July 1, 2014, to June 30, 2016, was employed. The data were for single episodes of care up to 52 weeks. Survival analysis (cox proportional hazards regression) assessed the relationship of personal characteristics, socio-economic status, payment for services, type of substance use, comprehensive care and social support with counselling for up to a year. Results indicated that age, having services paid for by public means, was associated with counselling adherence. Primary heroin use patients had a higher risk of counselling adherence failure than patients who primarily used non-medicinal prescription substances. Treatment agencies may benefit from funding and using evidence-based practices for primary heroin use patients and young adults to better engage and retain these populations in treatment.