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Workplace
Original research
Occupation and COVID-19 mortality in England: a national linked data study of 14.3 million adults
  1. Vahe Nafilyan1,2,
  2. Piotr Pawelek3,
  3. Daniel Ayoubkhani3,
  4. Sarah Rhodes4,
  5. Lucy Pembrey5,
  6. Melissa Matz2,6,
  7. Michel Coleman6,
  8. Claudia Allemani6,
  9. Ben Windsor-Shellard1,
  10. Martie van Tongeren7,
  11. Neil Pearce8
  1. 1 Health Analysis Division, Office for National Statistics, Newport, UK
  2. 2 Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, London, UK
  3. 3 Methodology Division, Office for National Statistics, Newport, Newport, UK
  4. 4 Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, Manchester, UK
  5. 5 Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  6. 6 Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  7. 7 Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK
  8. 8 Epidemiology and Population Health, London School of Hygiene, London, UK
  1. Correspondence to Dr Vahe Nafilyan, Office for National Statistics, Newport, Newport, UK; vahe.nafilyan{at}ons.gov.uk

Abstract

Objectives 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.

Methods 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.

Results 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.

Conclusions 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.

  • COVID-19
  • occupational health

Data availability statement

Data may be obtained from a third party and are not publicly available. The data used in this study are available on the Office for National Statistics (ONS) Secure Research Service for Accredited researchers as the Public Health Research Database. Researchers can apply for accreditation through the Research Accreditation Service.

This article is made freely available for personal 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.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/oemed-2021-107818

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The data used in this study are available on the Office for National Statistics (ONS) Secure Research Service for Accredited researchers as the Public Health Research Database. Researchers can apply for accreditation through the Research Accreditation Service.

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    Footnotes

    • Twitter @martievt

    • Contributors Study conceptualisation was led by VN and NP. All authors contributed to the development of the research question, study design, with development of statistical aspects led by VN, NP and PP. VN and PP were involved in data specification, curation and collection. VN and PP conducted and checked the statistical analyses. All authors contributed to the interpretation of the results. VN and NP wrote the first draft of the paper. All authors contributed to the critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. VN had full access to all data in the study and takes responsibility of the integrity of the data and the accuracy of the data analysis. The lead author (VN) is the garantor and affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

    • Funding This work was supported by funding through the National Core Study 'PROTECT' programme, managed by the Health and Safety Executive on behalf of HM Government and by a grant from the Colt Foundation (CF/05/20).

    • 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.