Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants

  1. Miriam Mutambudzi
  2. Claire Niedzwiedz
  3. Ewan Beaton Macdonald
  4. Alastair Leyland
  5. Frances Mair
  6. Jana Anderson
  7. Carlos Celis-Morales
  8. John Cleland
  9. John Forbes
  10. Jason Gill
  11. Claire Hastie
  12. Frederick Ho
  13. Bhautesh Jani
  14. Daniel F Mackay
  15. Barbara Nicholl
  16. Catherine O'Donnell
  17. Naveed Sattar
  18. Paul Welsh
  19. Jill P Pell
  20. Srinivasa Vittal Katikireddi
  21. Evangelia Demou

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

To investigate severe COVID-19 risk by occupational group.

Methods

Baseline UK Biobank data (2006–10) for England were linked to SARS-CoV-2 test results from Public Health England (16 March to 26 July 2020). Included participants were employed or self-employed at baseline, alive and aged <65 years in 2020. Poisson regression models were adjusted sequentially for baseline demographic, socioeconomic, work-related, health, and lifestyle-related risk factors to assess risk ratios (RRs) for testing positive in hospital or death due to COVID-19 by three occupational classification schemes (including Standard Occupation Classification (SOC) 2000).

Results

Of 120 075 participants, 271 had severe COVID-19. Relative to non-essential workers, healthcare workers (RR 7.43, 95% CI 5.52 to 10.00), social and education workers (RR 1.84, 95% CI 1.21 to 2.82) and other essential workers (RR 1.60, 95% CI 1.05 to 2.45) had a higher risk of severe COVID-19. Using more detailed groupings, medical support staff (RR 8.70, 95% CI 4.87 to 15.55), social care (RR 2.46, 95% CI 1.47 to 4.14) and transport workers (RR 2.20, 95% CI 1.21 to 4.00) had the highest risk within the broader groups. Compared with white non-essential workers, non-white non-essential workers had a higher risk (RR 3.27, 95% CI 1.90 to 5.62) and non-white essential workers had the highest risk (RR 8.34, 95% CI 5.17 to 13.47). Using SOC 2000 major groups, associate professional and technical occupations, personal service occupations and plant and machine operatives had a higher risk, compared with managers and senior officials.

Conclusions

Essential workers have a higher risk of severe COVID-19. These findings underscore the need for national and organisational policies and practices that protect and support workers with an elevated risk of severe COVID-19.

Article activity feed

  1. Version published to 10.1136/oemed-2020-106731
  2. Version published to 10.1101/2020.05.22.20109892v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.05.22.20109892: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: The UK Biobank study received ethical approval from the NHS National Research Ethics Service North West (16/NW/0274) and all participants provided written informed consent.
    Randomizationnot detected.
    BlindingOccupational groupings were performed blind to COVID-19 status.
    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:
    Our findings should be considered in light of several limitations. Baseline data were collected 1014 years ago, and we are unable to fully account for potential changes in health, lifestyle, sociodemographic and employment status. Further, the UK Biobank has low participation from ethnic minorities and low-income adults (28). As participation in research studies is non-random this may lead to collider bias and increase the risk of inaccurate associations not generalizable to the general population (29,30). The number of cases does not allow for an assessment of risk of COVID-19 for more detailed occupational groups and necessitates the grouping of occupations into broad exposure categories, which may have led to some exposure misclassification. Multiple testing may increase the probability of false positives, but using only our primary outcome of severe COVID-19 risk and broad subgroups mitigates this issue (31). Our results also reflect circumstances during the early phase of the pandemic in March to July 2020. Risks may differ over time, as the extent of physical distancing measures, work patterns and structures or availability of PPE changes. Our outcome measure is also a measure of severe acute disease and so results may be different for asymptomatic cases, those who experienced symptoms who were not tested, or those who experience long-term effects (32). Our findings are corroborated by preliminary research reporting higher risk of COVID-19 in essential workers (2,14-16,...

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.05.22.20109892v1 on medRxiv