Occupation and Educational Attainment Characteristics Associated With COVID-19 Mortality by Race and Ethnicity in California.
Occupation and Educational Attainment Characteristics Associated With COVID-19 Mortality by Race and Ethnicity in California.
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DOI：
10.1001/jamanetworkopen.2022.8406
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发表时间：
2022-04-01
影响因子：
13.8
通讯作者：
Glymour, M. Maria
中科院分区：
文献类型：
--
作者：
Matthay, Ellicott C.;Duchowny, Kate A.;Riley, Alicia R.;Thomas, Marilyn D.;Chen, Yea-Hung;Bibbins-Domingo, Kirsten;Glymour, M. Maria
这项队列研究通过种族和族裔评估了加州职业与新冠肺炎死亡率之间的关系。在新冠肺炎死亡率方面，教育程度和职业特征方面的不平等与种族和族裔不平等有多大程度的关联？在这项针对加利福尼亚州2,500万劳动适龄成年人的队列研究中，种族和民族之间教育和职业分布的差异与新冠肺炎死亡率中的种族和民族不平等有关，特别是对拉丁裔成年人来说。如果每个工作年龄的加州人都有与最低风险的教育和职业职位相关的新冠肺炎死亡风险，那么这一人口中的死亡人数估计会减少8441人(43%)。教育和职业劣势是与新冠肺炎死亡率风险相关的重要因素，但消除与低教育、基本、现场和低工资工作相关的可避免的过度风险不太可能足以实现公平。新冠肺炎死亡率中的种族和民族不平等可能是由职业和教育推动的，但评估这些机制的证据很少。评估职业特征或教育程度是否解释了种族和民族与新冠肺炎死亡率之间的关联。这项以人口为基础的回溯性队列研究对18岁至65岁的加州人进行了研究，将新冠肺炎死亡人数与种族和民族、性别、年龄、美国出生地、居住地区、教育和职业定义的阶层内的人口估计数联系起来。分析时间为2020年9月至2022年2月。与新冠肺炎相关的教育和职业特征(基本部门、远程工作选项、工资)。截至2021年2月12日，加利福尼亚州所有确认的新冠肺炎死亡病例。这项研究估计了如果每个种族和民族有(1)与白人的教育和职业分布相关的新冠肺炎死亡率风险，以及(2)与风险最低的教育和职业职位相关的新冠肺炎死亡率风险。在25名 235 092参与者(平均年龄40[14]岁；12名 730 395[50%]男性)中，14名 783死于新冠肺炎，8名 125 565(32%)拥有学士或以上学位，13名 345 829(53%)在基本部门工作，11名 783 017(47%)无法远程工作，12名 812 095(51%)的年薪低于51 700美元。新冠肺炎死亡率从白人女性和亚裔女性每10万 中15例死亡到拉丁裔男性每100 000中139例死亡不等。考虑到年龄、出生地和居住地区的差异，如果所有种族和民族的新冠肺炎死亡率与白人的职业特征(部门、远程工作、工资)相关，拉丁裔男性的新冠肺炎死亡率将降低10%(95%CI，6%至14%)，但黑人男性的新冠肺炎死亡率将增加5%(95%CI，−8%至17%)。如果所有工作年龄的加州人都有与最低风险的教育和职业职位(学士学位、非必需品、远程工作和最高工资五分之一)相关的新冠肺炎死亡率，那么劳动年龄成年人的新冠肺炎死亡率将降低43%(减少8441例死亡；95%可信区间，32%-54%)，其中拉丁裔男性(避免3755例死亡；95%可信区间，3304-4255例死亡)和拉美裔女性(避免2329例死亡；95%可信区间，2038年-2621例死亡)的绝对风险降低幅度最大。在这项以人口为基础的对加州劳动年龄成年人的队列研究中，职业不利与拉丁裔男性过高的新冠肺炎死亡率有关。对于所有种族和民族来说，与低教育、基本、现场和低工资工作相关的过度风险占新冠肺炎死亡率的很大一部分。
This cohort study evaluates the association between occupation and COVID-19 mortality by race and ethnicity in California. To what extent are inequities in educational attainment and occupational characteristics associated with racial and ethnic inequities in COVID-19 mortality? In this cohort study of 25 million working-age adults in California, differences in the distribution of education and occupation across racial and ethnic groups were associated with racial and ethnic inequities in COVID-19 mortality, particularly for Latinx adults. If every working-age Californian had the COVID-19 mortality risk associated with the lowest-risk educational and occupational position, there would have been an estimated 8441 (43%) fewer deaths in this population. Educational and occupational disadvantage are important factors associated with risk for COVID-19 mortality, but eliminating avoidable excess risk associated with low-education, essential, on-site, and low-wage jobs is unlikely to be sufficient alone to achieve equity. Racial and ethnic inequities in COVID-19 mortality may be driven by occupation and education, but limited evidence has assessed these mechanisms. To estimate whether occupational characteristics or educational attainment explained the associations between race and ethnicity and COVID-19 mortality. This population-based retrospective cohort study of Californians aged 18 to 65 years linked COVID-19 deaths to population estimates within strata defined by race and ethnicity, gender, age, nativity in the US, region of residence, education, and occupation. Analysis was conducted from September 2020 to February 2022. Education and occupational characteristics associated with COVID-19 exposure (essential sector, telework option, wages). All confirmed COVID-19 deaths in California through February 12, 2021. The study estimated what COVID-19 mortality would have been if each racial and ethnic group had (1) the COVID-19 mortality risk associated with the education and occupation distribution of White people and (2) the COVID-19 mortality risk associated with the lowest-risk educational and occupational positions. Of 25 235 092 participants (mean [SD] age, 40 [14] years; 12 730 395 [50%] men), 14 783 died of COVID-19, 8 125 565 (32%) had a Bachelor’s degree or higher, 13 345 829 (53%) worked in essential sectors, 11 783 017 (47%) could not telework, and 12 812 095 (51%) had annual wages under $51 700. COVID-19 mortality ranged from 15 deaths per 100 000 for White women and Asian women to 139 deaths per 100 000 for Latinx men. Accounting for differences in age, nativity, and region of residence, if all races and ethnicities had the COVID-19 mortality associated with the occupational characteristics of White people (sector, telework, wages), COVID-19 mortality would be reduced by 10% (95% CI, 6% to 14%) for Latinx men, but increased by 5% (95% CI, −8% to 17%) for Black men. If all working-age Californians had the COVID-19 mortality associated with the lowest-risk educational and occupational position (Bachelor’s degree, nonessential, telework, and highest wage quintile), there would have been 43% fewer COVID-19 deaths among working-age adults (8441 fewer deaths; 95% CI, 32%-54%), with the largest absolute risk reductions for Latinx men (3755 deaths averted; 95% CI, 3304-4255 deaths) and Latinx women (2329 deaths averted; 95% CI, 2038-2621 deaths). In this population-based cohort study of working-age California adults, occupational disadvantage was associated with excess COVID-19 mortality for Latinx men. For all racial and ethnic groups, excess risk associated with low-education, essential, on-site, and low-wage jobs accounted for a substantial fraction of COVID-19 mortality.
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影响因子：
3.7
作者：
Chen YH;Glymour M;Riley A;Balmes J;Duchowny K;Harrison R;Matthay E;Bibbins-Domingo K
通讯作者：
Bibbins-Domingo K
DOI：
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发表时间：
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影响因子：
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DOI：
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发表时间：
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期刊：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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