Risk factors associated with SARS-CoV-2 infection in a multiethnic cohort of United Kingdom healthcare workers (UK-REACH): A cross-sectional analysis.
Risk factors associated with SARS-CoV-2 infection in a multiethnic cohort of United Kingdom healthcare workers (UK-REACH): A cross-sectional analysis.
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DOI：
10.1371/journal.pmed.1004015
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发表时间：
2022-05
期刊：
影响因子：
15.8
通讯作者：
中科院分区：
文献类型：
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医护人员，特别是来自少数族裔的医护人员，与一般人相比，感染严重急性呼吸系统综合症冠状病毒2(SARS-CoV-2)的风险高得不成比例。然而，关于人口和职业因素如何影响少数民族卫生工作者感染风险的证据不足。我们使用了2020年12月至2021年3月进行的英国卫生保健工作者中的种族和冠状病毒疾病结果研究(新冠肺炎)队列研究(UK-REACH)队列研究的基线问卷数据进行了横断面分析。我们使用Logistic回归分析了人口、家庭和职业危险因素与不同人群中SARS-CoV-2感染(由聚合酶链式反应、血清学或疑似新冠肺炎定义)的相关性。主要的兴趣暴露是自我报告的种族。在2020年3月英国首次全国封锁期间工作的10,772名医务工作者中，年龄中值为45岁(四分位数范围为35至54岁)，751%为女性，29.6%来自少数族裔群体。共有2,496人(23.2%)报告曾感染SARS-CoV-2。完全调整后的模型包含以下因变量：人口因素(年龄、性别、种族、移民状况、贫困、宗教信仰)、家庭因素(与关键工人同居、合住公寓、家庭人数)、健康因素(是否有糖尿病或免疫抑制、吸烟史、防护状况、接种SARS-CoV-2疫苗状况)、家庭外社会融合程度和职业因素(工作角色、参与者工作的地区、使用公共交通工具上班、接触确诊的新冠肺炎患者、个人防护用品接触、气雾剂产生程序暴露、夜班模式、和英国工作场所地区)。调整后，与感染几率增加相关的人口和家庭因素包括较年轻的年龄、与其他关键工作者一起生活以及较高的宗教信仰。与感染几率增加相关的重要职业危险因素包括照顾更多新冠肺炎阳性患者(与无患者相比，≥21患者每周的OR2.59，95%CI为2.11~3.18)，从事护理或助产士工作(与医生相比，分别为1.3，1.11至1.53)，报告无法获得个人防护用品(1.29，1.17至1.43)，以及在救护车(2.00，1.56至2.58)或住院环境(1.55，1.38至1.75)工作。那些在重症监护病房工作的人比那些没有工作的人感染的可能性更小(0.76，0.64比0.92)。黑人医务工作者比他们的白人同事更有可能被感染，在调整了其他已知的风险因素后，这种影响减弱了。这项研究受到自我选择偏差的限制，研究的横截面性质意味着我们无法推断因果关系的方向。我们确定了与英国医务工作者感染SARS-CoV-2相关的关键社会人口学和职业危险因素，并确定了可能导致黑人少数民族医务工作者感染几率不成比例的因素。这些研究结果证明了社会和职业因素在造成新冠肺炎结果中种族差异方面的重要性，并应为政策提供依据，包括有针对性的疫苗接种战略和风险评估，旨在在未来的新冠肺炎大流行浪潮中保护卫生工作者。这项研究在ISRCTN(参考编号：ISRCTN11811602)上进行了前瞻性注册。Christopher A Martin及其同事在英国一组不同的医护人员中调查了人口、家庭和职业风险因素与SARS-CoV-2感染的关系。先前的研究表明，医护人员，特别是来自少数族裔群体的医护人员，患2019年冠状病毒病(新冠肺炎)的风险很高。这项研究旨在为这些群体面临新冠肺炎高风险的原因提供信息。我们对超过12,000名英国医务工作者(其中30%来自少数族裔)进行了一项电子调查，作为英国种族与新冠肺炎诊断和医疗工作者结果研究(UK-REACH)研究的一部分，以收集可能与新冠肺炎相关的家庭和工作因素的信息。与感染风险较高相关的家庭因素包括较年轻的年龄和与其他“关键工人”一起生活。与较高感染风险相关的职业因素包括照顾较多的新冠肺炎患者、从事护理或助产士工作、报告无法获得适当的个人防护设备(PPE)以及在医院住院和救护车环境中工作。来自某些少数族裔群体的妇女患新冠肺炎的风险高于白人妇女。影响新冠肺炎风险的家庭和职业因素在民族间存在差异。我们已经确定了英国医务人员患新冠肺炎的关键风险因素，并证明了影响新冠肺炎风险的家庭和工作因素存在种族差异。因此，这些因素可能解释了少数民族妇女面临新冠肺炎的高风险。随着大流行的继续，我们的发现可以用来识别和保护“处于危险”的卫生工作者。与所有这类研究一样，在解释我们的结果时需要谨慎，因为我们的结果可能会受到完成调查的卫生工作者群体与整个医护人员之间的差异的影响。
Healthcare workers (HCWs), particularly those from ethnic minority groups, have been shown to be at disproportionately higher risk of infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) compared to the general population. However, there is insufficient evidence on how demographic and occupational factors influence infection risk among ethnic minority HCWs. We conducted a cross-sectional analysis using data from the baseline questionnaire of the United Kingdom Research study into Ethnicity and Coronavirus Disease 2019 (COVID-19) Outcomes in Healthcare workers (UK-REACH) cohort study, administered between December 2020 and March 2021. We used logistic regression to examine associations of demographic, household, and occupational risk factors with SARS-CoV-2 infection (defined by polymerase chain reaction (PCR), serology, or suspected COVID-19) in a diverse group of HCWs. The primary exposure of interest was self-reported ethnicity. Among 10,772 HCWs who worked during the first UK national lockdown in March 2020, the median age was 45 (interquartile range [IQR] 35 to 54), 75.1% were female and 29.6% were from ethnic minority groups. A total of 2,496 (23.2%) reported previous SARS-CoV-2 infection. The fully adjusted model contained the following dependent variables: demographic factors (age, sex, ethnicity, migration status, deprivation, religiosity), household factors (living with key workers, shared spaces in accommodation, number of people in household), health factors (presence/absence of diabetes or immunosuppression, smoking history, shielding status, SARS-CoV-2 vaccination status), the extent of social mixing outside of the household, and occupational factors (job role, the area in which a participant worked, use of public transport to work, exposure to confirmed suspected COVID-19 patients, personal protective equipment [PPE] access, aerosol generating procedure exposure, night shift pattern, and the UK region of workplace). After adjustment, demographic and household factors associated with increased odds of infection included younger age, living with other key workers, and higher religiosity. Important occupational risk factors associated with increased odds of infection included attending to a higher number of COVID-19 positive patients (aOR 2.59, 95% CI 2.11 to 3.18 for ≥21 patients per week versus none), working in a nursing or midwifery role (1.30, 1.11 to 1.53, compared to doctors), reporting a lack of access to PPE (1.29, 1.17 to 1.43), and working in an ambulance (2.00, 1.56 to 2.58) or hospital inpatient setting (1.55, 1.38 to 1.75). Those who worked in intensive care units were less likely to have been infected (0.76, 0.64 to 0.92) than those who did not. Black HCWs were more likely to have been infected than their White colleagues, an effect which attenuated after adjustment for other known risk factors. This study is limited by self-selection bias and the cross sectional nature of the study means we cannot infer the direction of causality. We identified key sociodemographic and occupational risk factors associated with SARS-CoV-2 infection among UK HCWs, and have determined factors that might contribute to a disproportionate odds of infection in HCWs from Black ethnic groups. These findings demonstrate the importance of social and occupational factors in driving ethnic disparities in COVID-19 outcomes, and should inform policies, including targeted vaccination strategies and risk assessments aimed at protecting HCWs in future waves of the COVID-19 pandemic. The study was prospectively registered at ISRCTN (reference number: ISRCTN11811602). Christopher A Martin and colleagues investigate associations of demographic, household and occupational risk factors with SARS-CoV-2 infection in a diverse group of healthcare workers in the UK. Previous research has shown that healthcare workers (HCWs), particularly those from ethnic minority groups, are at high risk of Coronavirus Disease 2019 (COVID-19). This study aims to provide information about the reasons why these groups face a high risk of COVID-19. We conducted an electronic survey of over 12,000 United Kingdom HCWs (30% of whom were from ethnic minority groups) as part of the United Kingdom Research study into Ethnicity and COVID-19 diagnosis and outcomes in Healthcare workers (UK-REACH) study, in order to gather information about home and work factors that might be associated with COVID-19. Home factors associated with a higher risk of infection included younger age and living with other “key workers”. Occupational factors associated with a higher risk of infection included attending to higher numbers of COVID-19 patients, working in a nursing or midwifery role, reporting a lack of access to appropriate personal protective equipment (PPE), and working in hospital inpatient and ambulance settings. HCWs from certain ethnic minority groups were at higher risk of COVID-19 than White HCWs. There are differences in home and occupational factors that affect COVID-19 risk between ethnic groups. We have identified key risk factors for COVID-19 in UK HCWs and have demonstrated that ethnic groups differ in home and work factors that affect COVID-19 risk. Therefore, these factors may explain the high risk of COVID-19 faced by ethnic minority HCWs. Our findings can be used to identify and protect “at risk” HCWs as the pandemic continues. As with all studies of this kind, caution is required when interpreting our findings as our results may be influenced by the differences between the group of HCWs who completed our survey compared to the healthcare workforce as a whole.
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