Occupation and COVID-19 mortality in England: a national linked data study of 14.3 million adults
Occupation and COVID-19 mortality in England: a national linked data study of 14.3 million adults
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DOI：
10.1136/oemed-2021-107818
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发表时间：
2021-12-27
影响因子：
4.9
通讯作者：
Pearce, Neil
中科院分区：
文献类型：
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作者：
Nafilyan, Vahe;Pawelek, Piotr;Pearce, Neil
目的评估COVID-19死亡率的职业差异，并测试这些差异是否受到地区差异、种族和教育等因素的混淆，或由于非工作场所因素，如贫困或大流行前的健康状况。方法使用一项对居住在英格兰的1400多万40-64岁的人进行的队列研究，我们分析了2020年1月24日至2020年12月28日期间评估的涉及COVID-19的死亡的职业差异。我们估计了按性别和职业分层的每10万人年的年龄标准化死亡率（ASMR）。我们使用调整混杂因素的考克斯比例风险模型估计了职业对COVID-19死亡率的影响。我们进一步调整了非工作场所因素，并将职业的剩余影响解释为由于工作场所暴露于SARS-CoV-2。结果在男性中，ASMR最高的是出租车和出租车司机或司机，每10万人中有119.7人死亡（95%CI 98.0至141.4），其次是其他初级职业，每10万人中有106.5人死亡（84.5至132.4），护理人员和家庭护理人员为99.2人（74.5至129.4）。调整混杂因素后，许多职业的HR大大降低，但许多职业仍处于高风险状态。调整生活条件进一步降低了HR，许多职业不再处于过度风险中。对于大多数职业，混杂因素和介质以外的工作场所暴露于SARS-CoV-2解释了70%-80%的过度年龄调整的职业差异。结论工作条件在COVID-19死亡率中发挥作用，特别是在与患者或公众接触的职业中。然而，非工作场所因素也起了很大作用。
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.