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Original research
Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants
  1. Miriam Mutambudzi1,2,
  2. Claire Niedzwiedz3,
  3. Ewan Beaton Macdonald3,
  4. Alastair Leyland1,
  5. Frances Mair3,
  6. Jana Anderson3,
  7. Carlos Celis-Morales3,4,
  8. John Cleland5,
  9. John Forbes6,
  10. Jason Gill4,
  11. Claire Hastie3,
  12. Frederick Ho3,
  13. Bhautesh Jani3,
  14. Daniel F Mackay3,
  15. Barbara Nicholl3,
  16. Catherine O'Donnell3,
  17. Naveed Sattar4,
  18. Paul Welsh4,
  19. Jill P Pell3,
  20. Srinivasa Vittal Katikireddi1,
  21. Evangelia Demou1
  1. 1MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  2. 2Department of Public Health, Syracuse University, Syracuse, New York, USA
  3. 3Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  4. 4Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
  5. 5Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  6. 6School of Medicine, University of Limerick, Limerick, Ireland
  1. Correspondence to Dr Evangelia Demou, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G2 3QB, UK; Evangelia.Demou{at}


Objectives To investigate severe COVID-19 risk by occupational group.

Methods Baseline UK Biobank data (2006–10) for England were linked to SARS-CoV-2 test results from Public Health England (16 March to 26 July 2020). Included participants were employed or self-employed at baseline, alive and aged <65 years in 2020. Poisson regression models were adjusted sequentially for baseline demographic, socioeconomic, work-related, health, and lifestyle-related risk factors to assess risk ratios (RRs) for testing positive in hospital or death due to COVID-19 by three occupational classification schemes (including Standard Occupation Classification (SOC) 2000).

Results Of 120 075 participants, 271 had severe COVID-19. Relative to non-essential workers, healthcare workers (RR 7.43, 95% CI 5.52 to 10.00), social and education workers (RR 1.84, 95% CI 1.21 to 2.82) and other essential workers (RR 1.60, 95% CI 1.05 to 2.45) had a higher risk of severe COVID-19. Using more detailed groupings, medical support staff (RR 8.70, 95% CI 4.87 to 15.55), social care (RR 2.46, 95% CI 1.47 to 4.14) and transport workers (RR 2.20, 95% CI 1.21 to 4.00) had the highest risk within the broader groups. Compared with white non-essential workers, non-white non-essential workers had a higher risk (RR 3.27, 95% CI 1.90 to 5.62) and non-white essential workers had the highest risk (RR 8.34, 95% CI 5.17 to 13.47). Using SOC 2000 major groups, associate professional and technical occupations, personal service occupations and plant and machine operatives had a higher risk, compared with managers and senior officials.

Conclusions Essential workers have a higher risk of severe COVID-19. These findings underscore the need for national and organisational policies and practices that protect and support workers with an elevated risk of severe COVID-19.

  • physicians
  • health care workers
  • exposure assessment
  • public health
  • investigation of outbreaks of illness

Data availability statement

Data may be obtained from a third party and are not publicly available. This research has been conducted using the UK Biobank Resource (; application No 41686 & 17333).

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

Data may be obtained from a third party and are not publicly available. This research has been conducted using the UK Biobank Resource (; application No 41686 & 17333).

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  • Twitter @EvangeliaDemou

  • MM and CN contributed equally.

  • SVK and ED contributed equally.

  • Contributors SVK and ED conceived the idea for the study. ED, SVK, CLN, JPP and MM designed the study. CLN led and conducted the statistical analysis and was supported by MM. MM, CLN and ED drafted the manuscript. All authors contributed to the interpretation of the results, critically revised the paper and agreed on the final version for submission.

  • Funding We also acknowledge financial support from the Medical Research Council and Chief Scientist Office (MC_UU_12017/13; SPHSU13). CLN is supported by a Medical Research Council Fellowship (MR/R024774/1) and SVK by a NRS Senior Clinical Fellowship (SCAF/15).

  • Disclaimer The views and opinions expressed are those of the authors and do not necessarily reflect those of the above funding bodies.

  • Competing interests JPP is a member of the UK Biobank Scientific Steering Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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