Occupation and COVID-19 mortality in England: a national linked data study of 14.3 million adults

  1. Vahe Nafilyan
  2. Piotr Pawelek
  3. Daniel Ayoubkhani
  4. Sarah Rhodes
  5. Lucy Pembrey
  6. Melissa Matz
  7. Michel Coleman
  8. Claudia Allemani
  9. Ben Windsor-Shellard
  10. Martie van Tongeren
  11. Neil Pearce

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Abstract

To estimate occupational differences in COVID-19 mortality and test whether these are confounded by factors such as regional differences, ethnicity and education or due to non-workplace factors, such as deprivation or prepandemic health.

Methods

Using a cohort study of over 14 million people aged 40–64 years living in England, we analysed occupational differences in death involving COVID-19, assessed between 24 January 2020 and 28 December 2020.

We estimated age-standardised mortality rates (ASMRs) per 100 000 person-years at risk stratified by sex and occupation. We estimated the effect of occupation on COVID-19 mortality using Cox proportional hazard models adjusted for confounding factors. We further adjusted for non-workplace factors and interpreted the residual effects of occupation as being due to workplace exposures to SARS-CoV-2.

Results

In men, the ASMRs were highest among those working as taxi and cab drivers or chauffeurs at 119.7 deaths per 100 000 (95% CI 98.0 to 141.4), followed by other elementary occupations at 106.5 (84.5 to 132.4) and care workers and home carers at 99.2 (74.5 to 129.4). Adjusting for confounding factors strongly attenuated the HRs for many occupations, but many remained at elevated risk. Adjusting for living conditions reduced further the HRs, and many occupations were no longer at excess risk. For most occupations, confounding factors and mediators other than workplace exposure to SARS-CoV-2 explained 70%–80% of the excess age-adjusted occupational differences.

Conclusions

Working conditions play a role in COVID-19 mortality, particularly in occupations involving contact with patients or the public. However, there is also a substantial contribution from non-workplace factors.

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  1. Version published to 10.1136/oemed-2021-107818
  2. ScreenIT

    SciScore for 10.1101/2021.05.12.21257123: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot 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:
    The main limitation of our study is that the information on occupation is nine years out of date. Our exposure is therefore likely to be misclassified for a proportion of people, because they have left the labour force or changed occupation since 2011. To mitigate measurement error, we restricted our analysis to people aged 40-64 years, who had a relatively high occupational stability, as shown in our analysis of a large longitudinal household survey. Exposure misclassification is nonetheless likely to result in biasing of the estimated hazard ratios towards the null value of 1.0. However, we still observed strongly elevated hazard ratios for many occupations. Misclassification of occupation would be constant across our various analyses and could not explain the substantial decrease in most hazard ratios after adjustment for confounders. On the other hand, the confounders that we have addressed are also likely to be misclassified to some extent. Given that adjustment for confounders produced large changes in the estimated occupational associations, it is possible that if more accurate or detailed confounder data were available, adjustment would have driven the hazard ratio estimates even lower towards the null value of 1.0. Another limitation is that our dataset excludes recent migrants, since it is based on people who were enumerated at the 2011 Census. Finally, some deaths may not have been registered by the end of the study period if they had been sent to a coroner, which ...

    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.

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

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  3. Version published to 10.1101/2021.05.12.21257123v1 on medRxiv