Centers for Disease Control and Prevention, Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA.
School of Dental Medicine, Pacific Northwest University, Yakima, Washington, USA.
Am J Ind Med. 2024 Oct;67(10):920-932. doi: 10.1002/ajim.23645. Epub 2024 Aug 9.
Early studies during the COVID-19 pandemic suggested dental occupations were among the highest risk for exposure to SARs-CoV-2 because of multiple factors increasing exposure, including close proximity to unmasked patients and performance of aerosol-generating procedures. However, to date, few studies have investigated COVID-19 deaths in United States dental occupations, and compared COVID-19 deaths among healthcare occupations.
We analyzed 2020 mortality data collected by the National Center for Health Statistics' National Vital Statistics System. Multivariable logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals for COVID-19 as the underlying cause of death in relation to occupation in working-age decedents (≤65 years), after adjusting for age, sex, race/ethnicity, education, and medical conditions associated with severe COVID-19.
Dental occupations did not have significantly higher risk for COVID-19 death when compared to all other occupations combined. Among healthcare occupations with frequent, direct patient- or client interactions, LPNs and LVNs, and speech and language pathologists had significantly elevated adjusted ORs for COVID-19 death when compared to dentists, dental hygienists, or dental assistants. Similarly, nurse practitioners had significantly higher ORs for COVID-19 mortality than dentists or dental hygienists, and approached significance when compared to dental assistants. Conversely, massage therapists and other health diagnosing and treating practitioners had significantly lower adjusted ORs for COVID-19 death compared with dental occupations.
Our study highlights potential differences in work-related transmission of SARs-CoV-2 and subsequent COVID-19 deaths in healthcare occupations, and furthers a previously limited understanding of COVID-19 deaths in healthcare occupations in 2020, before COVID-19 vaccine availability. Our results indicate that dental occupations were not among the highest, nor lowest risk, healthcare occupations for COVID-19 deaths in 2020, despite their known risks of direct exposure.
在 COVID-19 大流行期间的早期研究表明，由于多种因素增加了暴露风险，牙科职业的暴露风险位居 SARS-CoV-2 最高之列，这些因素包括与未戴口罩的患者近距离接触和进行产生气溶胶的程序。然而，迄今为止，很少有研究调查美国牙科职业的 COVID-19 死亡人数，并比较了医疗保健职业中的 COVID-19 死亡人数。
我们分析了国家卫生统计中心国家生命统计系统收集的 2020 年死亡率数据。多变量逻辑回归用于生成在工作年龄死者（≤65 岁）中，COVID-19 作为死亡根本原因的优势比（OR）和 95%置信区间，在调整年龄、性别、种族/民族、教育程度和与严重 COVID-19 相关的医疗条件后，与职业有关。
与所有其他职业相比，牙科职业的 COVID-19 死亡风险并没有显著增加。在经常与患者或客户直接互动的医疗保健职业中，与牙医、牙科保健师或牙科助理相比，注册护士 (LPN) 和注册护师 (LVN)，以及言语病理学家的 COVID-19 死亡调整后的 OR 显著升高。同样，与牙医或牙科保健师相比，执业护士 (NP) 的 COVID-19 死亡率 OR 更高，与牙科助理相比则接近显著水平。相比之下，与牙科职业相比，按摩治疗师和其他健康诊断和治疗从业者的 COVID-19 死亡调整后的 OR 显著降低。
我们的研究强调了在医疗保健职业中，与工作相关的 SARS-CoV-2 传播以及随后的 COVID-19 死亡之间可能存在差异，并进一步了解了 2020 年 COVID-19 疫苗供应之前医疗保健职业中 COVID-19 死亡人数有限。我们的结果表明，尽管牙科职业已知存在直接接触的风险，但在 2020 年，牙科职业的 COVID-19 死亡风险并不是最高或最低的医疗保健职业之一。
