Disparities in COVID-19 fatalities among working Californians

  1. Kristin J. Cummings
  2. John Beckman
  3. Matthew Frederick
  4. Robert Harrison
  5. Alyssa Nguyen
  6. Robert Snyder
  7. Elena Chan
  8. Kathryn Gibb
  9. Andrea Rodriguez
  10. Jessie Wong
  11. Erin L. Murray
  12. Seema Jain
  13. Ximena Vergara

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Information on U.S. COVID-19 mortality rates by occupation is limited. We aimed to characterize 2020 COVID-19 fatalities among working Californians to inform preventive strategies.

Methods

We identified laboratory-confirmed COVID-19 fatalities with dates of death in 2020 by matching death certificates to the state’s COVID-19 case registry. Working status for decedents aged 18–64 years was determined from state employment records, death certificates, and case registry data and classified as “confirmed working,” “likely working,” or “not working.” We calculated age-adjusted overall and occupation-specific COVID-19 mortality rates using 2019 American Community Survey denominators.

Results

COVID-19 accounted for 8,050 (9.9%) of 81,468 fatalities among Californians 18–64 years old. Of these decedents, 2,486 (30.9%) were matched to state employment records and classified as “confirmed working.” The remainder were classified as “likely working” (n = 4,121 [51.2%]) or “not working” (n = 1,443 [17.9%]) using death certificate and case registry data. Confirmed and likely working COVID-19 decedents were predominantly male (76.3%), Latino (68.7%), and foreign-born (59.6%), with high school or less education (67.9%); 7.8% were Black. The overall age-adjusted COVID-19 mortality rate was 30.0 per 100,000 workers (95% confidence interval [CI], 29.3–30.8). Workers in nine occupational groups had age-adjusted mortality rates higher than this overall rate, including those in farming (78.0; 95% CI, 68.7–88.2); material moving (77.8; 95% CI, 70.2–85.9); construction (62.4; 95% CI, 57.7–67.4); production (60.2; 95% CI, 55.7–65.0); and transportation (57.2; 95% CI, 52.2–62.5) occupations. While occupational differences in mortality were evident across demographic groups, mortality rates were three-fold higher for male compared with female workers and three- to seven-fold higher for Latino and Black workers compared with Asian and White workers.

Conclusion

Californians in manual labor and in-person service occupations experienced disproportionate COVID-19 mortality, with the highest rates observed among male, Latino, and Black workers; these occupational group should be prioritized for prevention.

Article activity feed

  1. Version published to 10.1371/journal.pone.0266058
  2. Rapid Reviews Infectious Diseases

    Yi Li

    Review 2: "Disparities in COVID-19 Fatalities among Working Californians"

    While reviewers note potential underreporting and demographic ambiguities, they agree that the preprint does outline such limitations and ultimately sheds light on important health disparities.

  3. Rapid Reviews Infectious Diseases

    Isobel Routledge

    Review 1: "Disparities in COVID-19 Fatalities among Working Californians"

    While reviewers note potential underreporting and demographic ambiguities, they agree that the preprint does outline such limitations and ultimately sheds light on important health disparities.

  5. ScreenIT

    SciScore for 10.1101/2021.11.10.21266195: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: Ethical Considerations: The California Health and Human Services Agency’s Committee for the Protection of Human Subjects exempted the study from institutional review board review.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analyses were conducted using SAS software V.9.4 (SAS Institute, Inc, Cary, North Carolina, USA) and R Studio Version 4.0.2
    SAS
    suggested: (SASqPCR, RRID:SCR_003056)
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    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:
    This study has several limitations. Our definition of COVID-19 fatality required a positive polymerase chain reaction (PCR) test result for SARS-CoV-2. Thus, COVID-19 decedents in California who did not undergo PCR testing were excluded, potentially underestimating the occupational burden of COVID-19 deaths. The working status of some decedents may have been misclassified, such as unemployed decedents classified as likely working. Our use of “usual occupation” listed on the death certificate may have misclassified the occupation of some decedents who were working in a different occupation at the time of infection. In addition, we used ACS data from 2019, as 2020 data were not yet available. Pandemic-related changes in employment that occurred in California in 2020 may mean that denominators were overestimated (47). As a result, we may have underestimated the COVID-19 mortality rates for some occupations. Finally, by focusing on working-age decedents, we did not address the potential burden of COVID-19 on workers 65 years of age and older. Our findings have implications for prevention. Given the likelihood that COVID-19 fatalities among working Californians included work-related cases, the occupations with elevated mortality rates should be prioritized by public health and regulatory authorities to ensure that non-pharmaceutical interventions, such as physical distancing, use of respiratory protection or face coverings, and adequate ventilation, are implemented in the workplac...

    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.

    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.

  6. Version published to 10.1101/2021.11.10.21266195v1 on medRxiv