Excess mortality associated with the COVID-19 pandemic among Californians 18–65 years of age, by occupational sector and occupation: March through November 2020
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- Evaluated articles (Rapid Reviews Infectious Diseases)
Abstract
Though SARS-CoV-2 outbreaks have been documented in occupational settings and in-person essential work has been suspected as a risk factor for COVID-19, occupational differences in excess mortality have, to date, not been examined. Such information could point to opportunities for intervention, such as vaccine prioritization or regulations to enforce safer work environments.
Methods and findings
Using autoregressive integrated moving average models and California Department of Public Health data representing 356,188 decedents 18–65 years of age who died between January 1, 2016 and November 30, 2020, we estimated pandemic-related excess mortality by occupational sector and occupation, with additional stratification of the sector analysis by race/ethnicity. During these first 9 months of the COVID-19 pandemic, working-age adults experienced 11,628 more deaths than expected, corresponding to 22% relative excess and 46 excess deaths per 100,000 living individuals. Sectors with the highest relative and per-capita excess mortality were food/agriculture (39% relative excess; 75 excess deaths per 100,000), transportation/logistics (31%; 91 per 100,000), manufacturing (24%; 61 per 100,000), and facilities (23%; 83 per 100,000). Across racial and ethnic groups, Latino working-age Californians experienced the highest relative excess mortality (37%) with the highest excess mortality among Latino workers in food and agriculture (59%; 97 per 100,000). Black working-age Californians had the highest per-capita excess mortality (110 per 100,000), with relative excess mortality highest among transportation/logistics workers (36%). Asian working-age Californians had lower excess mortality overall, but notable relative excess mortality among health/emergency workers (37%), while White Californians had high per-capita excess deaths among facilities workers (70 per 100,000).
Conclusions
Certain occupational sectors are associated with high excess mortality during the pandemic, particularly among racial and ethnic groups also disproportionately affected by COVID-19. In-person essential work is a likely venue of transmission of coronavirus infection and must be addressed through vaccination and strict enforcement of health orders in workplace settings.
Article activity feed
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Nathaniel Lewis
Review 1: "Excess Mortality Associated with the COVID-19 Pandemic Among Californians 18–65 years of Age, By Occupational Sector and Occupation: March Through October 2020"
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Strength of evidence
Reviewers: N Lewis (Utah Department of Health) | 📗📗📗📗◻️
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SciScore for 10.1101/2021.01.21.21250266: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:
We acknowledge limitations to the study, including misclassification of occupation in death certificates due to coarse categories or inaccurate reports. The decedent’s primary occupation is typically reported by the next of kin …
SciScore for 10.1101/2021.01.21.21250266: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:
We acknowledge limitations to the study, including misclassification of occupation in death certificates due to coarse categories or inaccurate reports. The decedent’s primary occupation is typically reported by the next of kin who may not be able to precisely describe the work. The primary occupation, which is reported on the death certificate, may not match the most recent occupation, which is more likely to drive occupational risk. These limitations would in general attenuate apparent differences across occupational sectors but are unlikely to account for our primary results. Our study places a powerful lens on the unjust impact of the COVID-19 pandemic on mortality of working age adults in different occupations. Our analysis is among the first to identify non-healthcare in-person essential work, such as food and agriculture, as a predictor of pandemic-related mortality. Essential workers—especially those in the food/agriculture, transportation/logistics, facilities, and manufacturing sectors—face increased risks for pandemic-related mortality. Shutdown policies by definition do not protect essential workers and must be complemented with workplace modifications and prioritized vaccine distribution. If indeed these workers are essential, we must be swift and decisive in enacting measures that will treat their lives as such.
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 scite Reference Check: We found no unreliable references.
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.
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SciScore for 10.1101/2021.01.21.21250266: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:
We acknowledge limitations to the study, including misclassification of occupation in death certificates due to coarse categories or inaccurate reports. The decedent’s primary occupation is typically reported by the next of …
SciScore for 10.1101/2021.01.21.21250266: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not 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:
We acknowledge limitations to the study, including misclassification of occupation in death certificates due to coarse categories or inaccurate reports. The decedent’s primary occupation is typically reported by the next of kin who may not be able to precisely describe the work. The primary occupation, which is reported on the death certificate, may not match the most recent occupation, which is more likely to drive occupational risk. These limitations would in general attenuate apparent differences across occupational sectors but are unlikely to account for our primary results. Our study places a powerful lens on the unjust impact of the COVID-19 pandemic on mortality of working age adults in different occupations. Our analysis is among the first to identify non-healthcare in-person essential work, such as food and agriculture, as a predictor of pandemic-related mortality. Essential workers—especially those in the food/agriculture, transportation/logistics, facilities, and manufacturing sectors—face increased risks for pandemic-related mortality. Shutdown policies by definition do not protect essential workers and must be complemented with workplace modifications and prioritized vaccine distribution. If indeed these workers are essential, we must be swift and decisive in enacting measures that will treat their lives as such.
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.
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.
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