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Wachtler B, Beese F, Demirer I, Haller S, Pförtner TK, Wahrendorf M, Grabka MM, Hoebel J. Education and pandemic SARS-CoV-2 infections in the German working population - the mediating role of working from home. Scand J Work Environ Health 2024; 50:168-177. [PMID: 38346224 PMCID: PMC11064849 DOI: 10.5271/sjweh.4144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES SARS-CoV-2 infections were unequally distributed during the pandemic, with those in disadvantaged socioeconomic positions being at higher risk. Little is known about the underlying mechanism of this association. This study assessed to what extent educational differences in SARS-CoV-2 infections were mediated by working from home. METHODS We used data of the German working population derived from the seroepidemiological study "Corona Monitoring Nationwide - Wave 2 (RKI-SOEP-2)" (N=6826). Infections were assessed by seropositivity against SARS-CoV-2 antigens and self-reports of previous PCR-confirmed infections from the beginning of the pandemic until study participation (November 2021 - February 2022). The frequency of working from home was assessed between May 2021 and January 2022.We used the Karlson-Holm-Breen (KHB) method to decompose the effect of education on SARS-CoV-2 infections. RESULTS Individuals with lower educational attainment had a higher risk for SARS-CoV-2 infection (adjusted prevalence ratio of low versus very high = 1.76, 95% confidence interval 1.08-2.88; P=0.023). Depending on the level of education, between 27% (high education) and 58% (low education) of the differences in infection were mediated by the frequency of working from home. CONCLUSIONS Working from home could prevent SARS-CoV-2 infections and contribute to the explanation of socioeconomic inequalities in infection risks. Wherever possible, additional capacities to work remotely, particularly for occupations that require lower educational attainment, should be considered as an important measure of pandemic preparedness. Limitations of this study are the observational cross-sectional design and that the temporal order between infection and working from home remained unclear.
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Affiliation(s)
- Benjamin Wachtler
- ORCID ID 0000-0002-3959-5676, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany.
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Tondel M, Nordquist T, Helgesson M, Svartengren M. COVID-19: incidence and mortality in Sweden comparing all foreign-born to all Swedish-born individuals in different occupations in an unvaccinated cohort of year 2020. Occup Environ Med 2024; 81:136-141. [PMID: 38267211 PMCID: PMC10958322 DOI: 10.1136/oemed-2023-108952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES The aim was to analyse the incidence and mortality of COVID-19 in immigrants compared with Swedish born in inpatients and outpatient registers, respectively. METHODS The study population included all persons 20-88 years of age living in Sweden, 31 December 2019, including 1 676 516 foreign-born persons and 6 037 151 Swedish-born persons. The outcome was clinical cases of COVID-19 with a positive PCR test (ICD-10 U07.01) or without a positive PCR test (U07.2) from 1 January to 31 December 2020. Persons 20-64 years of age were classified with occupational titles according to the Swedish Standard Classification of Occupations. Residing municipality of each individual was coded according to the Swedish Association of Local Authorities. Relative risks (RR) were calculated by sex in 5 years age bands using Swedish born as reference. Age-adjusted RRs (adj RR) with 95% CIs were calculated in a Poisson regression model. Rural municipalities were used as the reference category. RESULTS Foreign born had consistently higher RRs in COVID-19, regardless of sex, with a peak in 50-69 years of age. Foreign born had a higher RR of death in COVID-19 above 50 years and 40 years of age in women and men, respectively. Among occupations, male drivers had the highest adj RR 4.37 (95% CI 3.45 to 5.54) and 5.09 (4.26 to 6.07) in outpatients and inpatients, respectively (U07.1). Persons living in commuting municipalities did not show any consistent increased risk for COVID-19. CONCLUSION Foreign born have a higher risk of COVID-19 compared with Swedish-born individuals at any age and occupation before vaccination began in 2021.
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Affiliation(s)
- Martin Tondel
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Tobias Nordquist
- Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Magnus Helgesson
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Health Equity and Working Life, Uppsala University, Uppsala, Sweden
| | - Magnus Svartengren
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
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Kromydas T, Demou E, Edge R, Gittins M, Katikireddi SV, Pearce N, van Tongeren M, Wilkinson J, Rhodes S. Occupational differences in the prevalence and severity of long-COVID: analysis of the Coronavirus (COVID-19) Infection Survey. Occup Environ Med 2023; 80:545-552. [PMID: 37770179 PMCID: PMC7615205 DOI: 10.1136/oemed-2023-108930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/08/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES To establish whether prevalence and severity of long-COVID symptoms vary by industry and occupation. METHODS We used Office for National Statistics COVID-19 Infection Survey (CIS) data (February 2021-April 2022) of working-age participants (16-65 years). Exposures were industry, occupation and major Standard Occupational Classification (SOC) group. Outcomes were self-reported: (1) long-COVID symptoms and (2) reduced function due to long-COVID. Binary (outcome 1) and ordered (outcome 2) logistic regression were used to estimate odds ratios (OR)and prevalence (marginal means). RESULTS Public facing industries, including teaching and education, social care, healthcare, civil service, retail and transport industries and occupations, had the highest likelihood of long-COVID. By major SOC group, those in caring, leisure and other services (OR 1.44, 95% CIs 1.38 to 1.52) had substantially elevated odds than average. For almost all exposures, the pattern of ORs for long-COVID symptoms followed SARS-CoV-2 infections, except for professional occupations (eg, some healthcare, education, scientific occupations) (infection: OR<1 ; long-COVID: OR>1). The probability of reporting long-COVID for industry ranged from 7.7% (financial services) to 11.6% (teaching and education); whereas the prevalence of reduced function by 'a lot' ranged from 17.1% (arts, entertainment and recreation) to 22%-23% (teaching and education and armed forces) and to 27% (not working). CONCLUSIONS The risk and prevalence of long-COVID differs across industries and occupations. Generally, it appears that likelihood of developing long-COVID symptoms follows likelihood of SARS-CoV-2 infection, except for professional occupations. These findings highlight sectors and occupations where further research is needed to understand the occupational factors resulting in long-COVID.
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Affiliation(s)
- Theocharis Kromydas
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rhiannon Edge
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Matthew Gittins
- Centre for Biostatistics, The University of Manchester, Manchester, UK
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Neil Pearce
- Faculty of Public Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
- Thomas Ashton Institute for Risk and Regulatory Research, The University of Manchester, Manchester, UK
| | - Jack Wilkinson
- Centre for Biostatistics, The University of Manchester, Manchester, UK
| | - Sarah Rhodes
- Centre for Biostatistics, The University of Manchester, Manchester, UK
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Svallfors S, Larsson EC, Puranen B, Ekström AM. COVID-19 vaccine hesitancy among first-generation immigrants living in Sweden. Eur J Public Health 2023:7179915. [PMID: 37229599 PMCID: PMC10395762 DOI: 10.1093/eurpub/ckad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND In many countries, immigrants face higher risks of contracting and dying from COVID-19 compared with the native-born population. Moreover, their COVID-19 vaccination uptake tends to be lower. This study aimed to investigate COVID-19 vaccine hesitancy in relation to sociodemographic characteristics, COVID-19-related exposures and social values, norms and perceptions among first-generation immigrants in Sweden. Vaccine hesitancy is an important public health issue to ensure protection against vaccine-preventable mortality and morbidity. METHODS Nation-wide representative data were collected by the Migrant World Values Survey. Descriptive and multinomial multivariate analyses were performed to analyze vaccine hesitancy among 2612 men and women aged ≥16 years. RESULTS One-quarter of the respondents expressed some degree of vaccine hesitancy; 5% said they would definitely not vaccinate, 7% probably not, 4% did not know and 7% did not want to answer. Young age, arriving to Sweden during the large migration wave in 2015, Eastern European origin, female gender, lower education and low trust in authorities, and less perceived benefits of vaccination were all significant determinants of vaccine hesitancy. CONCLUSIONS The results underscore the importance of trust in healthcare providers and government authorities. Additionally, the importance of providing adequate and targeted information about vaccination to groups who face the largest barriers to care, enabling informed decision-making about the benefits and risks of vaccination in relation to health risks. Given these health risks, it is crucial that government agencies and the health sector address the multiple social dimensions that shape the low vaccine uptake and, in turn, health equity.
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Affiliation(s)
- Signe Svallfors
- Department of Sociology, Stanford University, Stanford, CA, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Elin C Larsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Bi Puranen
- World Values Survey Association, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, South General Hospital, Venhälsan, Stockholm, Sweden
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Bonde JPE, Begtrup LM, Coggon D, Jensen JH, Flachs EM, Jakobsson K, Nielsen C, Nilsson K, Rylander L, Vilhelmsson A, Petersen KU, Tøttenborg SS. COVID-19-related hospital admission in spouses of partners in at-risk occupations. Scand J Work Environ Health 2023; 49:193-200. [PMID: 36749944 PMCID: PMC10621900 DOI: 10.5271/sjweh.4080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE This study aimed to quantify the risk of COVID-19-related hospital admission in spouses living with partners in at-risk occupations in Denmark during 2020-21. METHODS Within a registry-based cohort of all Danish employees (N=2 451 542), we identified cohabiting couples, in which at least one member (spouse) held a job that according to a job exposure matrix entailed low risk of occupational exposure to SARS-CoV-2 (N=192 807 employees, 316 COVID-19 hospital admissions). Risk of COVID-19-related hospital admission in such spouses was assessed according to whether their partners were in jobs with low, intermediate or high risk for infection. Overall and sex-specific incidence rate ratios (IRR) of COVID-19-related hospital admission were computed by Poisson regression with adjustment for relevant covariates. RESULTS The risk of COVID-19-related hospital admission was increased among spouses with partners in high-risk occupations [adjusted IRR (IRRadj)1.59, 95% confidence interval (CI) 1.1-2.2], but not intermediate-risk occupations (IRRadj 0.97 95% 0.8-1.3). IRR for having a partner in a high-risk job was elevated during the first three pandemic waves but not in the fourth (IRRadj 0.48 95% CI 0.2-1.5). Sex did not modify the risk of hospital admission. CONCLUSIONS SARS-CoV-2 transmission at the workplace may pose an increased risk of severe COVID-19 among spouses in low-risk jobs living with partners in high-risk jobs, which emphasizes the need for preventive measures at the workplace in future outbreaks of epidemic contagious disease. When available, effective vaccines seem essential.
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Affiliation(s)
- Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, DK-Copenhagen 2400 NV, Denmark.
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Rhodes S, Beale S, Wilkinson J, van Veldhoven K, Basinas I, Mueller W, Oude Hengel KM, Burdorf A, Peters S, Stokholm ZA, Schlünssen V, Kolstad H, Pronk A, Pearce N, Hayward A, van Tongeren M. Exploring the relationship between job characteristics and infection: Application of a COVID-19 job exposure matrix to SARS-CoV-2 infection data in the United Kingdom. Scand J Work Environ Health 2023; 49:171-181. [PMID: 36537299 PMCID: PMC10621898 DOI: 10.5271/sjweh.4076] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study aimed to assess whether workplace exposures as estimated via a COVID-19 job exposure matrix (JEM) are associated with SARS-CoV-2 in the UK. METHODS Data on 244 470 participants were available from the Office for National Statistics Coronavirus Infection Survey (CIS) and 16 801 participants from the Virus Watch Cohort, restricted to workers aged 20-64 years. Analysis used logistic regression models with SARS-CoV-2 as the dependent variable for eight individual JEM domains (number of workers, nature of contacts, contact via surfaces, indoor or outdoor location, ability to social distance, use of face covering, job insecurity, and migrant workers) with adjustment for age, sex, ethnicity, index of multiple deprivation (IMD), region, household size, urban versus rural area, and health conditions. Analyses were repeated for three time periods (i) February 2020 (Virus Watch)/April 2020 (CIS) to May 2021), (ii) June 2021 to November 2021, and (iii) December 2021 to January 2022. RESULTS Overall, higher risk classifications for the first six domains tended to be associated with an increased risk of infection, with little evidence of a relationship for domains relating to proportion of workers with job insecurity or migrant workers. By time there was a clear exposure-response relationship for these domains in the first period only. Results were largely consistent across the two UK cohorts. CONCLUSIONS An exposure-response relationship exists in the early phase of the COVID-19 pandemic for number of contacts, nature of contacts, contacts via surfaces, indoor or outdoor location, ability to social distance and use of face coverings. These associations appear to have diminished over time.
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Affiliation(s)
- Sarah Rhodes
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK.
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Bonde JPE, Begtrup LM, Jensen JH, Flachs EM, Schlünssen V, Kolstad HA, Jakobsson K, Nielsen C, Nilsson K, Rylander L, Vilhelmsson A, Petersen KKU, Soegaard Toettenborg S. Occupational risk of SARS-CoV-2 infection: a nationwide register-based study of the Danish workforce during the COVID-19 pandemic, 2020-2021. Occup Environ Med 2023; 80:202-208. [PMID: 36813540 PMCID: PMC10086477 DOI: 10.1136/oemed-2022-108713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Most earlier studies on occupational risk of COVID-19 covering the entire workforce are based on relatively rare outcomes such as hospital admission and mortality. This study examines the incidence of SARS-CoV-2 infection by occupational group based on real-time PCR (RT-PCR) tests. METHODS The cohort includes 2.4 million Danish employees, 20-69 years of age. All data were retrieved from public registries. The incidence rate ratios (IRRs) of first-occurring positive RT-PCR test from week 8 of 2020 to week 50 of 2021 were computed by Poisson regression for each four-digit Danish Version of the International Standard Classification of Occupations job code with more than 100 male and 100 female employees (n=205). Occupational groups with low risk of workplace infection according to a job exposure matrix constituted the reference group. Risk estimates were adjusted by demographic, social and health characteristics including household size, completed COVID-19 vaccination, pandemic wave and occupation-specific frequency of testing. RESULTS IRRs of SARS-CoV-2 infection were elevated in seven healthcare occupations and 42 occupations in other sectors, mainly social work activities, residential care, education, defence and security, accommodation and transportation. No IRRs exceeded 2.0. The relative risk in healthcare, residential care and defence/security declined across pandemic waves. Decreased IRRs were observed in 12 occupations. DISCUSSION We observed a modestly increased risk of SARS-CoV-2 infection among employees in numerous occupations, indicating a large potential for preventive actions. Cautious interpretation of observed risk in specific occupations is needed because of methodological issues inherent in analyses of RT-PCR test results and because of multiple statistical tests.
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Affiliation(s)
- Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark .,Department of Occupational and Environmental Medicine, Bispebjerg and Frederikberg Hospital, Copenhagen, Denmark
| | - Luise Moelenberg Begtrup
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederikberg Hospital, Copenhagen, Denmark
| | - Johan Høy Jensen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederikberg Hospital, Copenhagen, Denmark
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederikberg Hospital, Copenhagen, Denmark
| | - Vivi Schlünssen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik A Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Kristina Jakobsson
- Sahlgrenska Academy, University of Gothenburg, School of Public Health and Community Medicine, Gothenburg, Sweden
| | - Christel Nielsen
- Laboratory Medicine, Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Kerstin Nilsson
- Laboratory Medicine, Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Andreas Vilhelmsson
- Laboratory Medicine, Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | | | - Sandra Soegaard Toettenborg
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederikberg Hospital, Copenhagen, Denmark
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Sjörs Dahlman A, Anund A. Seroprevalence of SARS-CoV-2 antibodies among public transport workers in Sweden. JOURNAL OF TRANSPORT & HEALTH 2022; 27:101508. [PMID: 36188635 PMCID: PMC9515328 DOI: 10.1016/j.jth.2022.101508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Public transportation is an essential societal function in crisis situations like the coronavirus disease 2019 (COVID-19) pandemic. Bus drivers and other public transport workers are essential workers that need to keep working despite the risk of contagion. The SARS-CoV-2 virus may pose an occupational health risk to public transport workers and especially to bus drivers as they interact with passengers in a confined area. By analyzing antibodies towards SARS-CoV-2 proteins in blood samples it is possible to measure if an individual has been infected by COVID-19. Here, we report the prevalence of antibodies among bus drivers and other public transport employees in Stockholm, Sweden and relate it to socio-demographic factors. METHODS Seroprevalence of IgG antibodies towards SARS-CoV-2 proteins was investigated in a sample of 262 non-vaccinated public transport workers (182 men and 40 women) recruited between April 26 and May 7, 2021. Most of the participants were bus drivers (n = 222). The relationship between socio-demographic factors and seroprevalence was investigated with logistic regression. RESULTS The seroprevalence was 50% in the total sample of public transport workers. Among bus drivers, 51% were seropositive compared to 44% seropositive among the other public transport workers. The difference was not significant. The seroprevalence was higher than the national seroprevalence in Sweden during the same period (18.3% in non-vaccinated people aged 20-64 years). The logistic regression model using Wald forward selection showed that men had a higher risk of being seropositive (OR 2.7, 95% CI 1.3 - 5.8) and there was a higher risk with increasing number of people in the household (OR 1.3, 95% CI 1.1 - 1.6). CONCLUSIONS These findings could imply an occupational risk for COVID-19 infection among public transport workers. Infection control measures are warranted during virus epidemics to assure bus drives' safety and reduce transmission in public transport.
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Affiliation(s)
- Anna Sjörs Dahlman
- The Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden
- Department of Electrical Engineering and SAFER Vehicle and Traffic Safety Centre at Chalmers University of Technology, Gothenburg, Sweden
| | - Anna Anund
- The Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden
- Rehabilitation Medicine, Linköping University, Linköping, Sweden and Stockholm University, Stockholm Stress Centre, Stockholm, Sweden
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Rosengren A, Söderberg M, Lundberg CE, Lindgren M, Santosa A, Edqvist J, Åberg M, Gisslén M, Robertson J, Cronie O, Sattar N, Lagergren J, Brandén M, Björk J, Adiels M. COVID-19 in people aged 18-64 in Sweden in the first year of the pandemic: Key factors for severe disease and death. GLOBAL EPIDEMIOLOGY 2022; 4:100095. [PMID: 36447481 PMCID: PMC9683858 DOI: 10.1016/j.gloepi.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/17/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Studies on risk factors for severe COVID-19 in people of working age have generally not included non-working persons or established population attributable fractions (PAFs) for occupational and other factors. Objectives We describe the effect of job-related, sociodemographic, and other exposures on the incidence, relative risks and PAFs of severe COVID-19 in individuals aged 18-64. Methods We conducted a registry-based study in Swedish citizens aged 18-64 from 1 January 2020 to 1 February 2021 with respect to COVID-19-related hospitalizations and death. Results Of 6,205,459 persons, 272,043 (7.5%) were registered as infected, 3399 (0.05%) needed intensive care, and 620 (0.01%) died, with an estimated case fatality rate of 0.06% over the last 4-month period when testing was adequate. Non-Nordic origin was associated with a RR for need of intensive care of 3·13, 95%CI 2·91-3·36, and a PAF of 32·2% after adjustment for age, sex, work, region and comorbidities. In a second model with occupation as main exposure, and adjusted for age, sex, region, comorbidities and origin, essential workers had an RR of 1·51, 95%CI, 1·35-1·6, blue-collar workers 1·18, 95%CI 1·06-1·31, school staff 1·21, 95%CI 1·01-1·46, and health and social care workers 1·89, 95%CI 1·67-2·135) compared with people able to work from home, with altogether about 13% of the PAF associated with these occupations. Essential workers and blue-collar workers, but no other job categories had higher risk of death, adjusted RRs of 1·79, 95%CI 1·34-2·38 and 1·37, 95%CI 1·04-1·81, with adjusted PAFs of altogether 9%. Conclusion Among people of working age in Sweden, overall mortality and case fatality were low. Occupations that require physical presence at work were associated with elevated risk of needing intensive care for COVID-19, with 14% cases attributable to this factor, and 9% of deaths.
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Affiliation(s)
- Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Gothenburg, Sweden,Corresponding author at: Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mia Söderberg
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christina E. Lundberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Gothenburg, Sweden
| | - Ailiana Santosa
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Edqvist
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Regionhälsan, Gothenburg, Sweden
| | - Magnus Gisslén
- Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Josefina Robertson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ottmar Cronie
- Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Naveed Sattar
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Sweden,School of Cancer and Pharmaceutical Sciences, King's College London, United Kingdom
| | - Maria Brandén
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Stockholm, Sweden,Institute for Analytical Sociology (IAS), Linköping University, Norrköping, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden,Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cherrie M, Rhodes S, Wilkinson J, Mueller W, Nafilyan V, Tongeren MV, Pearce N. Longitudinal changes in proportionate mortality due to COVID-19 by occupation in England and Wales. Scand J Work Environ Health 2022; 48:611-620. [PMID: 35770926 PMCID: PMC10546610 DOI: 10.5271/sjweh.4048] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study aimed to understand whether the proportionate mortality of COVID-19 for various occupational groups has varied over the pandemic. METHODS We used the Office for National Statistics (ONS) mortality data for England and Wales. The deaths (20-64 years) were classified as either COVID-19-related using ICD-10 codes (U07.1, U07.2), or from other causes. Occupational data recorded at the time of death was coded using the SOC10 coding system into 13 groups. Three time periods (TP) were used: (i) January 2020 to September 2020; (ii) October 2020-May 2021; and (iii) June 2021-October 2021. We analyzed the data with logistic regression and compared odds of death by COVID-19 to other causes, adjusting for age, sex, deprivation, region, urban/rural and population density. RESULTS Healthcare professionals and associates had a higher proportionate odds of COVID-19 death in TP1 compared to non-essential workers but were not observed to have increased odds thereafter. Medical support staff had increased odds of death from COVID-19 during both TP1 and TP2, but this had reduced by TP3. This latter pattern was also seen for social care, food retail and distribution, and bus and coach drivers. Taxi and cab drivers were the only group that had higher odds of death from COVID-19 compared to other causes throughout the whole period under study [TP1: odds ratio (OR) 2.42, 95% confidence interval (CI) 1.99-2.93; TP2: OR 3.15, 95% CI 2.63-3.78; TP3: OR 1.7, 95% CI 1.26-2.29]. CONCLUSION Differences in the odds of death from COVID-19 between occupational groups has declined over the course of the pandemic, although some occupations have remained relatively high throughout.
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Affiliation(s)
- Mark Cherrie
- Institute of Occupational Medicine, Edinburgh, UK
| | - Sarah Rhodes
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, Manchester, UK
| | - Jack Wilkinson
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, Manchester, UK
| | | | - Vahe Nafilyan
- Health Analysis Division, Office for National Statistics, Newport, UK
| | - Martie Van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK
| | - Neil Pearce
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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11
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Hosseini P, Mueller W, Rhodes S, Pembrey L, van Tongeren M, Pearce N, Loh M, Fletcher T. Transmission and Control of SARS-CoV-2 in the Food Production Sector: A Rapid Narrative Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12104. [PMID: 36231415 PMCID: PMC9566159 DOI: 10.3390/ijerph191912104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
This review aimed to provide an overview of the literature assessing the extent of COVID-19 transmission in the food processing sector along with the risk factors associated with COVID-19 infection/mortality rates in this setting, and the preventive measures used to reduce transmission. An electronic search was conducted using scientific databases, including Web of Science, OVID, PubMed and MedRxiv. The search strategy identified 26 papers that met the inclusion criteria. Six of these studies were based in the UK and the country with the most papers was the USA, with a total of nine papers. Findings showed some evidence of a high transmission level of SARS-CoV-2 within some areas of the food production sector. Risk factors associated with the spread included ethnicity, poor ventilation, lack of social distancing and lack of sick pay. The preventative measures included/recommended were social distancing, testing, adequate ventilation, cleaning regimes and access to PPE. Additional research focusing on the food production sector could show the potential variations in transmission and risk between each sub-sector. Future research focusing on the application of various preventative measures and their efficacy by sub-sector would be beneficial, while further qualitative research could help provide in-depth information regarding knowledge gaps.
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Affiliation(s)
- Paniz Hosseini
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | | | - Sarah Rhodes
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester M13 9PL, UK
| | - Lucy Pembrey
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Martie van Tongeren
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester M13 9PL, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Miranda Loh
- Institute of Occupational Medicine, Edinburgh EH14 4AP, UK
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester M13 9PL, UK
| | - Tony Fletcher
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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12
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Fadel M, Gilbert F, Legeay C, Dubée V, Esquirol Y, Verdun-Esquer C, Dinh A, Sembajwe G, Goldberg M, Roquelaure Y, Leclerc A, Wiernik E, Zins M, Descatha A. Association between COVID-19 infection and work exposure assessed by the Mat-O-Covid job exposure matrix in the CONSTANCES cohort. Occup Environ Med 2022; 79:oemed-2022-108436. [PMID: 36126974 PMCID: PMC9606493 DOI: 10.1136/oemed-2022-108436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/01/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The COVID-19 pandemic has brought to light a new occupational health threat. We aimed to evaluate the association between COVID-19 infection and work exposure to SARS-CoV-2 assessed by a job-exposure matrix (JEM), in a large population cohort. We also estimated the population-attributable fraction among exposed subjects. METHODS We used the SAPRIS-SERO sample of the CONSTANCES cohort, limited to subjects actively working, and with a job code available and a questionnaire on extra work activities. The following outcomes were assessed: COVID-19 diagnosis was made by a physician; a seropositivity to the ELISA-S test ('serology strict') and ELISA-S test intermediate with positive ELISA-NP or a positive neutralising antibodies SN ('serology large'). Job exposure was assessed using Mat-O-Covid, an expert-based JEM with an Index used as a continuous variable and a threshold at 13/1000. RESULTS The sample included 18 999 subjects with 389 different jobs, 47.7% were men with a mean age of 46.2 years (±9.2 years). The Mat-O-Covid index taken as a continuous variable or with a threshold greater than 13/1000 was associated with all the outcomes in bivariable and multivariable logistic models. ORs were between 1.30 and 1.58, and proportion of COVID-19 attributable to work among exposed participants was between 20% and 40%. DISCUSSION Using the Mat-O-Covid JEM applied to a large population, we found a significant association between work exposure to SARS-CoV-2 and COVID-19 infection, though the estimation of attributable fraction among exposed people remained low to moderate. Further studies during other exposed periods and with other methods are necessary.
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Affiliation(s)
- Marc Fadel
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Ester Unit, SFR ICAT, CAPTV CDC, Angers, France
| | - Fabien Gilbert
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Ester Unit, SFR ICAT, CAPTV CDC, Angers, France
| | - Clément Legeay
- Infection Control and Prevention Unit, CHU Angers, Angers, France
| | - Vincent Dubée
- Infectious and Tropical Diseases Department, University Hospital CHU Angers, Angers, France
- Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Univ Angers, Nantes Université, INSERM, CNRS, Nantes, France
| | - Yolande Esquirol
- Occupational and Environmental Health Department, CHU, CERPOP UMR 1295, Université Paul Sabatier Toulouse 3, Inserm, Toulouse, France
| | - Catherine Verdun-Esquer
- Service Santé Travail Environnement, INSERM U1219, EPICENE, CHU de Bordeaux, Univ Bordeaux, Bordeaux, France
| | - Aurelien Dinh
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP (Paris Hospital), Paris Saclay University, Paris, France
| | - Grace Sembajwe
- Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine, Hofstra/ Northwell, Great Neck, New York, USA
| | - Marcel Goldberg
- Unité "Cohortes en Population" UMS 011, Inserm/Université de Paris/Université Paris Saclay/UVSQ, Villejuif, France
| | - Yves Roquelaure
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Ester Unit, SFR ICAT, CAPTV CDC, Angers, France
| | - Annette Leclerc
- Unité "Cohortes en Population" UMS 011, Inserm/Université de Paris/Université Paris Saclay/UVSQ, Villejuif, France
| | - Emmanuel Wiernik
- Unité "Cohortes en Population" UMS 011, Inserm/Université de Paris/Université Paris Saclay/UVSQ, Villejuif, France
| | - Marie Zins
- Unité "Cohortes en Population" UMS 011, Inserm/Université de Paris/Université Paris Saclay/UVSQ, Villejuif, France
| | - Alexis Descatha
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Ester Unit, SFR ICAT, CAPTV CDC, Angers, France
- Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine, Hofstra/ Northwell, Great Neck, New York, USA
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13
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Heinzerling A, Vergara XP, Gebreegziabher E, Beckman J, Wong J, Nguyen A, Khan S, Frederick M, Bui D, Chan E, Gibb K, Rodriguez A, Jain S, Cummings KJ. COVID-19 Outbreaks and Mortality Among Public Transportation Workers - California, January 2020-May 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1052-1056. [PMID: 35980867 PMCID: PMC9400527 DOI: 10.15585/mmwr.mm7133a4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Rhodes S, Wilkinson J, Pearce N, Mueller W, Cherrie M, Stocking K, Gittins M, Katikireddi SV, Tongeren MV. Occupational differences in SARS-CoV-2 infection: analysis of the UK ONS COVID-19 infection survey. J Epidemiol Community Health 2022; 76:jech-2022-219101. [PMID: 35817467 PMCID: PMC9484374 DOI: 10.1136/jech-2022-219101] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/28/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Concern remains about how occupational SARS-CoV-2 risk has evolved during the COVID-19 pandemic. We aimed to ascertain occupations with the greatest risk of SARS-CoV-2 infection and explore how relative differences varied over the pandemic. METHODS Analysis of cohort data from the UK Office of National Statistics COVID-19 Infection Survey from April 2020 to November 2021. This survey is designed to be representative of the UK population and uses regular PCR testing. Cox and multilevel logistic regression were used to compare SARS-CoV-2 infection between occupational/sector groups, overall and by four time periods with interactions, adjusted for age, sex, ethnicity, deprivation, region, household size, urban/rural neighbourhood and current health conditions. RESULTS Based on 3 910 311 observations (visits) from 312 304 working age adults, elevated risks of infection can be seen overall for social care (HR 1.14; 95% CI 1.04 to 1.24), education (HR 1.31; 95% CI 1.23 to 1.39), bus and coach drivers (1.43; 95% CI 1.03 to 1.97) and police and protective services (HR 1.45; 95% CI 1.29 to 1.62) when compared with non-essential workers. By time period, relative differences were more pronounced early in the pandemic. For healthcare elevated odds in the early waves switched to a reduction in the later stages. Education saw raises after the initial lockdown and this has persisted. Adjustment for covariates made very little difference to effect estimates. CONCLUSIONS Elevated risks among healthcare workers have diminished over time but education workers have had persistently higher risks. Long-term mitigation measures in certain workplaces may be warranted.
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Affiliation(s)
- Sarah Rhodes
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Jack Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Neil Pearce
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mark Cherrie
- Institute of Occupational Medicine, Edinburgh, UK
| | - Katie Stocking
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Matthew Gittins
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | | | - Martie Van Tongeren
- Centre for Occupation and Environmental Health, The University of Manchester, Manchester, UK
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15
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Hawkins D, Phan AT. Changes in drug poisoning mortality before and after the COVID-19 pandemic by occupation in Massachusetts. Am J Ind Med 2022; 65:556-566. [PMID: 35575411 PMCID: PMC9348253 DOI: 10.1002/ajim.23369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incidence of drug poisoning deaths has increased during the coronavirus disease 2019 (COVID-19) pandemic. Previous research has established that risks differ for drug poisoning death according to occupation, and that workers also have a different risk for exposure to and death from COVID-19. This study sought to determine whether workers in certain occupations had drug poisoning mortality rates that increased in 2020 (the first year of the COVID-19 pandemic) compared to the average mortality rate for workers in those occupations during the previous 3 years. METHODS Death certificates of Massachusetts residents who died from drug poisonings in 2017-2020 were obtained. Average mortality rates of drug poisoning according to occupation during the 2017-2019 period were compared to mortality rates in 2020. RESULTS Between the 2017-2019 period and 2020, mortality rates of drug poisoning increased significantly for workers in three occupational groups: food preparation and serving; healthcare support; and transportation and material moving. In these occupations, most of the increases in 2020 compared to 2017-2019 occurred in months after COVID-19 pandemic cases and deaths increased in Massachusetts. CONCLUSION Mortality rates from drug poisonings increased substantially in several occupations in 2020 compared to previous years. Further research should examine the role of occupational factors in this increase in drug poisoning mortality rates during the COVID-19 pandemic. Particular attention should be given to determine the role that exposure to severe acute respiratory syndrome coronavirus 2, work stress, and financial stress due to job insecurity played in these increases.
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Affiliation(s)
- Devan Hawkins
- Public Health Program, Schools of Arts and Sciences MCPHS University Boston Massachusetts USA
| | - Anh Tuan Phan
- Schools of Pharmacy MCPHS University Boston Massachusetts USA
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16
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Mat-O-Covid: Validation of a SARS-CoV-2 Job Exposure Matrix (JEM) Using Data from a National Compensation System for Occupational COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095733. [PMID: 35565128 PMCID: PMC9105377 DOI: 10.3390/ijerph19095733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 02/01/2023]
Abstract
Background. We aimed to assess the validity of the Mat-O-Covid Job Exposure Matrix (JEM) on SARS-CoV-2 using compensation data from the French National Health Insurance compensation system for occupational-related COVID-19. Methods. Deidentified compensation data for occupational COVID-19 in France were obtained between August 2020 and August 2021. The case acceptance was considered as the reference. Mat-O-Covid is an expert-based French JEM on workplace exposure to SARS-CoV-2. Bi- and multivariable models were used to study the association between the exposure assessed by Mat-O-Covid and the reference, as well as the area under the curve (AUC), sensitivity, specificity, predictive values, and likelihood ratios. Results. In the 1140 cases included, there was a close association between the Mat-O-Covid index and the reference (p < 0.0001). The overall predictivity was good, with an AUC of 0.78 and an optimal threshold at 13 per thousand. Using Youden’s J statistic resulted in 0.67 sensitivity and 0.87 specificity. Both positive and negative likelihood ratios were significant: 4.9 [2.4−6.4] and 0.4 [0.3−0.4], respectively. Discussion. It was possible to assess Mat-O-Covid’s validity using data from the national compensation system for occupational COVID-19. Though further studies are needed, Mat-O-Covid exposure assessment appears to be accurate enough to be used in research.
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17
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Matthay EC, Duchowny KA, Riley AR, Thomas MD, Chen YH, Bibbins-Domingo K, Glymour MM. Occupation and Educational Attainment Characteristics Associated With COVID-19 Mortality by Race and Ethnicity in California. JAMA Netw Open 2022; 5:e228406. [PMID: 35452107 PMCID: PMC9034406 DOI: 10.1001/jamanetworkopen.2022.8406] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Racial and ethnic inequities in COVID-19 mortality may be driven by occupation and education, but limited evidence has assessed these mechanisms. OBJECTIVE To estimate whether occupational characteristics or educational attainment explained the associations between race and ethnicity and COVID-19 mortality. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study of Californians aged 18 to 65 years linked COVID-19 deaths to population estimates within strata defined by race and ethnicity, gender, age, nativity in the US, region of residence, education, and occupation. Analysis was conducted from September 2020 to February 2022. EXPOSURES Education and occupational characteristics associated with COVID-19 exposure (essential sector, telework option, wages). MAIN OUTCOMES AND MEASURES All confirmed COVID-19 deaths in California through February 12, 2021. The study estimated what COVID-19 mortality would have been if each racial and ethnic group had (1) the COVID-19 mortality risk associated with the education and occupation distribution of White people and (2) the COVID-19 mortality risk associated with the lowest-risk educational and occupational positions. RESULTS Of 25 235 092 participants (mean [SD] age, 40 [14] years; 12 730 395 [50%] men), 14 783 died of COVID-19, 8 125 565 (32%) had a Bachelor's degree or higher, 13 345 829 (53%) worked in essential sectors, 11 783 017 (47%) could not telework, and 12 812 095 (51%) had annual wages under $51 700. COVID-19 mortality ranged from 15 deaths per 100 000 for White women and Asian women to 139 deaths per 100 000 for Latinx men. Accounting for differences in age, nativity, and region of residence, if all races and ethnicities had the COVID-19 mortality associated with the occupational characteristics of White people (sector, telework, wages), COVID-19 mortality would be reduced by 10% (95% CI, 6% to 14%) for Latinx men, but increased by 5% (95% CI, -8% to 17%) for Black men. If all working-age Californians had the COVID-19 mortality associated with the lowest-risk educational and occupational position (Bachelor's degree, nonessential, telework, and highest wage quintile), there would have been 43% fewer COVID-19 deaths among working-age adults (8441 fewer deaths; 95% CI, 32%-54%), with the largest absolute risk reductions for Latinx men (3755 deaths averted; 95% CI, 3304-4255 deaths) and Latinx women (2329 deaths averted; 95% CI, 2038-2621 deaths). CONCLUSIONS AND RELEVANCE In this population-based cohort study of working-age California adults, occupational disadvantage was associated with excess COVID-19 mortality for Latinx men. For all racial and ethnic groups, excess risk associated with low-education, essential, on-site, and low-wage jobs accounted for a substantial fraction of COVID-19 mortality.
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Affiliation(s)
| | - Kate A. Duchowny
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Alicia R. Riley
- Department of Sociology, University of California, Santa Cruz
| | - Marilyn D. Thomas
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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