Predictors of SARS-CoV-2 infection in a multi-ethnic cohort of United Kingdom healthcare workers: a prospective nationwide cohort study (UK-REACH)

  1. Christopher A. Martin
  2. Daniel Pan
  3. Carl Melbourne
  4. Lucy Teece
  5. Avinash Aujayeb
  6. Rebecca F. Baggaley
  7. Luke Bryant
  8. Sue Carr
  9. Bindu Gregary
  10. Amit Gupta
  11. Anna L. Guyatt
  12. Catherine John
  13. I Chris McManus
  14. Joshua Nazareth
  15. Laura B. Nellums
  16. Rubina Reza
  17. Sandra Simpson
  18. Martin D. Tobin
  19. Katherine Woolf
  20. Stephen Zingwe
  21. Kamlesh Khunti
  22. Keith R. Abrams
  23. Laura J. Gray
  24. Manish Pareek

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Abstract

Introduction

Healthcare workers (HCWs), particularly those from ethnic minority groups, have been shown to be at disproportionately higher risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) compared to the general population. However, there is insufficient evidence on how demographic and occupational factors influence infection risk among ethnic minority HCWs.

Methods

We conducted a cross-sectional analysis using data from the United Kingdom Research study into Ethnicity And COVID-19 Outcomes in Healthcare workers (UK-REACH) cohort study. We used logistic regression to examine associations of demographic, household and occupational predictor variables with SARS-CoV-2 infection (defined by PCR, serology or suspected COVID-19) in a diverse group of HCWs.

Results

2,496 of the 10,772 HCWs (23.2%) who worked during the first UK national lockdown in March 2020 reported previous SARS-CoV-2 infection. In an adjusted model, demographic and household factors associated with increased odds of infection included younger age, living with other key workers and higher religiosity. Important occupational risk factors associated with increased odds of infection included attending to a higher number of COVID-19 positive patients (aOR 2.49, 95%CI 2.03–3.05 for ≥21 patients per week vs none), working in a nursing or midwifery role (1.35, 1.15– 1.58, compared to doctors), reporting a lack of access to personal protective equipment (1.27, 1.15 – 1.41) and working in an ambulance (1.95, 1.52–2.50) or hospital inpatient setting (1.54, 1.37 – 1.74). Those who worked in Intensive Care Units were less likely to have been infected (0.76, 0.63–0.90) than those who did not. Black HCWs were more likely to have been infected than their White colleagues, an effect which attenuated after adjustment for other known predictors.

Conclusions

We identified key sociodemographic and occupational risk factors associated with SARS-CoV-2 infection amongst UK HCWs, and have determined factors that might contribute to a disproportionate odds of infection in HCWs from Black ethnic groups. These findings demonstrate the importance of social and occupational factors in driving ethnic disparities in COVID-19 outcomes, and should inform policies, including targeted vaccination strategies and risk assessments aimed at protecting HCWs in future waves of the COVID-19 pandemic.

Trial registration

ISRCTN 11811602

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  1. ScreenIT

    SciScore for 10.1101/2021.12.16.21267934: (What is this?)

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

    Table 1: Rigor

    EthicsConsent: Those interested could create a user profile, read the participant information sheet and, if they were willing, sign an online consent form.
    IRB: ) Ethical approval: The study was approved by the Health Research Authority (Brighton and Sussex Research Ethics Committee; ethics reference: 20/HRA/4718).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysis9 For the main analysis, ethnicity was categorised into five broad ethnic groups (White, Asian, Black, Mixed and Other) to maximise the statistical power to test differences between groups.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were conducted using Stata 17 (StataCorp. 2021. Stata Statistical Software:
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    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:
    Our study has a number of limitations. There was potential for selection/responder bias, however comparison with the NHS workforce shows our sample to be representative, albeit with a lower proportion of ancillary staff (bias in the UK-REACH cohort study has been explored elsewhere36). As with any consented cohort study there is the potential for self-selection bias. The cross-sectional nature of the study means we cannot infer the direction of causality, since results may be vulnerable to reverse causation and residual confounding. HCWs who thought they had been infected prior to widespread testing and subsequently tested negative for SARS-CoV-2 infection later in the pandemic would be coded as uninfected in our analysis. We may, therefore, have underestimated infection prevalence. Reassuringly, as noted above, the proportion of infected HCWs is in-line with estimates from other UK studies. PCR and serology status are self-reported, although given the implications of positive SARS-CoV-2 tests in a HCW population, we do not expect recall bias to have much effect on our outcome measure. In conclusion, we identified key sociodemographic and occupational factors associated with SARS-CoV-2 infection amongst UK HCWs in a large national cohort study. These findings are of urgent public health importance, especially in light of the emergence of a highly transmissible variant of SARS-CoV-2 (omicron), against which vaccination may be less effective.37 The results should inform policie...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    ISRCTN11811602NANA

    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.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2021.12.16.21267934v1 on medRxiv