Risk of hospital admission with covid-19 among teachers compared with healthcare workers and other adults of working age in Scotland, March 2020 to July 2021: population based case-control study
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Abstract
Objective
To determine the risk of hospital admission with covid-19 and severe covid-19 among teachers and their household members, overall and compared with healthcare workers and adults of working age in the general population.
Design
Population based nested case-control study.
Setting
Scotland, March 2020 to July 2021, during defined periods of school closures and full openings in response to covid-19.
Participants
All cases of covid-19 in adults aged 21 to 65 (n=132 420) and a random sample of controls matched on age, sex, and general practice (n=1 306 566). Adults were identified as actively teaching in a Scottish school by the General Teaching Council for Scotland, and their household members were identified through the unique property reference number. The comparator groups were adults identified as healthcare workers in Scotland, their household members, and the remaining general population of working age.
Main outcome measures
The primary outcome was hospital admission with covid-19, defined as having a positive test result for SARS-CoV-2 during hospital admission, being admitted to hospital within 28 days of a positive test result, or receiving a diagnosis of covid-19 on discharge from hospital. Severe covid-19 was defined as being admitted to intensive care or dying within 28 days of a positive test result or assigned covid-19 as a cause of death.
Results
Most teachers were young (mean age 42), were women (80%), and had no comorbidities (84%). The risk (cumulative incidence) of hospital admission with covid-19 was <1% for all adults of working age in the general population. Over the study period, in conditional logistic regression models adjusted for age, sex, general practice, race/ethnicity, deprivation, number of comorbidities, and number of adults in the household, teachers showed a lower risk of hospital admission with covid-19 (rate ratio 0.77, 95% confidence interval 0.64 to 0.92) and of severe covid-19 (0.56, 0.33 to 0.97) than the general population. In the first period when schools in Scotland reopened, in autumn 2020, the rate ratio for hospital admission in teachers was 1.20 (0.89 to 1.61) and for severe covid-19 was 0.45 (0.13 to 1.55). The corresponding findings for household members of teachers were 0.91 (0.67 to 1.23) and 0.73 (0.37 to 1.44), and for patient facing healthcare workers were 2.08 (1.73 to 2.50) and 2.26 (1.43 to 3.59). Similar risks were seen for teachers in the second period, when schools reopened in summer 2021. These values were higher than those seen in spring/summer 2020, when schools were mostly closed.
Conclusion
Compared with adults of working age who are otherwise similar, teachers and their household members were not found to be at increased risk of hospital admission with covid-19 and were found to be at lower risk of severe covid-19. These findings should reassure those who are engaged in face-to-face teaching.
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SciScore for 10.1101/2021.02.05.21251189: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization This study, described in detail elsewhere,9 includes all individuals in Scotland who are “cases” of COVID-19 (see case definition below), and for each case ten controls randomly selected from the Scottish population who are of the same age (in single years) and sex, and are registered at the same general practice as the case, but who did not (on or before that date) themselves meet the case definition. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the …SciScore for 10.1101/2021.02.05.21251189: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization This study, described in detail elsewhere,9 includes all individuals in Scotland who are “cases” of COVID-19 (see case definition below), and for each case ten controls randomly selected from the Scottish population who are of the same age (in single years) and sex, and are registered at the same general practice as the case, but who did not (on or before that date) themselves meet the case definition. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations: This was a large and largely complete sample of teachers, and crucially the outcome data was obtained in the same manner for the different occupational groups such that valid comparisons can be made between them, especially for “harder” outcomes such as hospitalisation and admission to intensive care. Nonetheless, there are a number of limitations. First, a small number of GTCS registrants could not be linked to healthcare records. Secondly, the incidence and therefore precision of the estimates was low for hospitalisation and severe COVID-19. Thirdly, the variant of concern (VOC) mutation25 did not become dominant in Scotland until mid-December to January, and so we do not yet know how applicable these findings are to this mutation. Finally, it is important to note that, although the relative risks to teachers was low, as an occupational group, some teachers will nonetheless be at high absolute risk of severe COVID-19 due to combinations of other risk factors such as older age, male sex and underlying conditions. Such individuals should not be considered low risk by virtue of being teachers. Nonetheless since, as we found, most teachers (and to a lesser extent healthcare workers) were young, female, lived in less deprived areas and had no known underlying conditions, the majority of teachers will be at low absolute risk of severe COVID-19 and hospitalisation with COVID-19. Conclusion: The majority of teachers were young, female and had few comorbidities and are ...
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.
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