Health Analysis Division, Office for National Statistics, Newport, UK
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, London, UK.
Occup Environ Med. 2022 Jul;79(7):433-441. doi: 10.1136/oemed-2021-107818. Epub 2021 Dec 27.
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.
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.
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.
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.
估计 COVID-19 死亡率的职业差异，并检验这些差异是否受到区域差异、种族和教育等因素的影响，或者是否由于非工作场所因素（如贫困或大流行前的健康状况）所致。
利用一项针对英格兰 1400 多万 40-64 岁人群的队列研究，我们分析了 COVID-19 死亡涉及的职业差异，评估时间为 2020 年 1 月 24 日至 2020 年 12 月 28 日。我们按性别和职业分层，计算了每 10 万人年风险的年龄标准化死亡率（ASMR）。我们使用 Cox 比例风险模型估计职业对 COVID-19 死亡率的影响，并调整了混杂因素。我们进一步调整了非工作场所因素，并将职业的残余影响解释为 SARS-CoV-2 工作场所暴露所致。
在男性中，出租车和出租车司机或司机的 ASMR 最高，为每 10 万人 119.7 例（95%CI 98.0 至 141.4），其次是其他初级职业，为每 10 万人 106.5 例（84.5 至 132.4）和护理人员和家庭护理人员，为每 10 万人 99.2 例（74.5 至 129.4）。调整混杂因素后，许多职业的 HR 明显降低，但仍有许多职业处于高风险状态。调整生活条件后，HR 进一步降低，许多职业不再处于超额风险状态。对于大多数职业，除了 SARS-CoV-2 工作场所暴露之外，混杂因素和中介因素解释了 70%-80%的超额年龄调整职业差异。
工作条件在 COVID-19 死亡率中起一定作用，特别是在涉及与患者或公众接触的职业中。然而，非工作场所因素也有很大的贡献。
