Article Text

Original research
Risks of COVID-19 by occupation in NHS workers in England
Free
  1. Diana A van der Plaat1,
  2. Ira Madan2,3,
  3. David Coggon4,
  4. Martie van Tongeren5,
  5. Rhiannon Edge6,
  6. Rupert Muiry2,
  7. Vaughan Parsons2,3,
  8. Paul Cullinan1
  1. 1 National Heart and Lung Institute, Imperial College London, London, UK
  2. 2 Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
  3. 3 School of Population Health and Environmental Sciences, King's College London, London, UK
  4. 4 MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
  5. 5 Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
  6. 6 Lancaster Medical School, Lancaster University, Lancaster, UK
  1. Correspondence to Dr Ira Madan, Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust, London, London, UK; ira.madan{at}kcl.ac.uk

Abstract

Objective To quantify occupational risks of COVID-19 among healthcare staff during the first wave (9 March 2020–31 July 2020) of the pandemic in England.

Methods We used pseudonymised data on 902 813 individuals employed by 191 National Health Service trusts to explore demographic and occupational risk factors for sickness absence ascribed to COVID-19 (n=92 880). We estimated ORs by multivariable logistic regression.

Results With adjustment for employing trust, demographic characteristics and previous frequency of sickness absence, risk relative to administrative/clerical occupations was highest in ‘additional clinical services’ (care assistants and other occupations directly supporting those in clinical roles) (OR 2.31 (2.25 to 2.37)), registered nursing and midwifery professionals (OR 2.28 (2.23 to 2.34)) and allied health professionals (OR 1.94 (1.88 to 2.01)) and intermediate in doctors and dentists (OR 1.55 (1.50 to 1.61)). Differences in risk were higher after the employing trust had started to care for documented patients with COVID-19, and were reduced, but not eliminated, following additional adjustment for exposure to infected patients or materials, assessed by a job-exposure matrix. For prolonged COVID-19 sickness absence (episodes lasting >14 days), the variation in risk by staff group was somewhat greater.

Conclusions After allowance for possible bias and confounding by non-occupational exposures, we estimated that relative risks for COVID-19 among most patient-facing occupations were between 1.5 and 2.5. The highest risks were in those working in additional clinical services, nursing and midwifery and in allied health professions. Better protective measures for these staff groups should be a priority. COVID-19 may meet criteria for compensation as an occupational disease in some healthcare occupations.

Trial registration number ISRCTN36352994.

  • COVID-19

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors All authors contributed to the planning, conduct, analyses and reporting of this manuscript as outlined below. DAvdP (statistician) was responsible for the statistical aspects of analysis and interpretation of the quantitative aspects of the study. IM (Consultant Occupational Physician and Reader) was cochief investigator with responsibility for advising on study design, analysis and interpretation of results. DC (Emeritus Professor of Occupational and Environmental Medicine) was responsible for advising on methodological design, analysis and interpretation of results. MvT (Professor of Occupational and Environmental Medicine) was responsible for advising on study design, analysis and interpretation of results. RE (Lecturer in Population Health) was responsible for advising on study design, analysis and interpretation of results. RM (Research assistant) was responsible for scoping out and reviewing the emerging literature. VP (Research manager) was responsible for overseeing the set-up and delivery of the study, and facilitated data collection. PC (Professor in Occupational and Environmental Respiratory Disease) was chief investigator with responsibility for advising on study design, analysis and interpretation of results. Had overall responsibility for the management and delivery of the study.

  • Funding This study was funded by a grant from the COLT Foundation. Award reference: N/A

  • Competing interests None declared.

  • 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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