Risks of COVID-19 by occupation in NHS workers in England

  1. Diana A van der Plaat
  2. Ira Madan
  3. David Coggon
  4. Martie van Tongeren
  5. Rhiannon Edge
  6. Rupert Muiry
  7. Vaughan Parsons
  8. Paul Cullinan

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Abstract

To quantify occupational risks of COVID-19 among healthcare staff during the first wave (9 March 2020–31 July 2020) of the pandemic in England.

Methods

We used pseudonymised data on 902 813 individuals employed by 191 National Health Service trusts to explore demographic and occupational risk factors for sickness absence ascribed to COVID-19 (n=92 880). We estimated ORs by multivariable logistic regression.

Results

With adjustment for employing trust, demographic characteristics and previous frequency of sickness absence, risk relative to administrative/clerical occupations was highest in ‘additional clinical services’ (care assistants and other occupations directly supporting those in clinical roles) (OR 2.31 (2.25 to 2.37)), registered nursing and midwifery professionals (OR 2.28 (2.23 to 2.34)) and allied health professionals (OR 1.94 (1.88 to 2.01)) and intermediate in doctors and dentists (OR 1.55 (1.50 to 1.61)). Differences in risk were higher after the employing trust had started to care for documented patients with COVID-19, and were reduced, but not eliminated, following additional adjustment for exposure to infected patients or materials, assessed by a job-exposure matrix. For prolonged COVID-19 sickness absence (episodes lasting >14 days), the variation in risk by staff group was somewhat greater.

Conclusions

After allowance for possible bias and confounding by non-occupational exposures, we estimated that relative risks for COVID-19 among most patient-facing occupations were between 1.5 and 2.5. The highest risks were in those working in additional clinical services, nursing and midwifery and in allied health professions. Better protective measures for these staff groups should be a priority. COVID-19 may meet criteria for compensation as an occupational disease in some healthcare occupations.

Trial registration number

ISRCTN36352994 .

Article activity feed

  1. Version published to 10.1136/oemed-2021-107628
  2. Version published to 10.1101/2021.04.08.21255099v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.04.08.21255099: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A limitation was that staff group distinguished only broad categories of work. Ideally, analysis would have discriminated between occupations in finer detail, but access to that level of information was precluded by data protection rules. Instead, therefore, we constructed a JEM to group the 659 occupations in the ESR database to eight exposure categories. As an indicator of occupational exposure to infection from patients, the JEM should have been superior to staff group. For example, within medical and dental personnel, it distinguished specialists in intensive care, who could be expected to have high exposure to patients with Covid-19, from orthopaedic surgeons, whose patients would be expected to have lower prevalence of the disease. However, it was far from perfect. Even in the detailed occupational classification to which the JEM was applied, some job categories were heterogeneous (e.g. nurses in medical wards could not be distinguished from those working in orthopaedics or gynaecology). Moreover, it did not allow for changes in duties during the epidemic, or for use of PPE and its effectiveness. We would expect any misclassification by the JEM to be non-differential with respect to Covid-19 outcomes, and therefore to bias risk estimates for exposure categories towards the null. Thus, the observed associations with the two highest exposure categories, even after adjustment for staff group, support its validity. However, the varying specificity of occupational categories...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  4. Version published to 10.1101/2021.04.08.21255099v1 on medRxiv