Occupational risk of COVID-19 related hospital admission in Denmark 2020–2021: a follow-up study

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Abstract

Objective

Mounting evidence indicates increased risk of COVID-19 among healthcare personnel, but the evidence on risks in other occupations is limited. In this study, we quantify the occupational risk of COVID-19-related hospital admission in Denmark during 2020–2021.

Methods

The source population included 2.4 million employees age 20–69 years. All information was retrieved from public registers. The risk of COVID-19 related hospital admission was examined in 155 occupations with at least 2000 employees (at-risk, N=1 620 231) referenced to a group of mainly office workers defined by a COVID-19 job exposure matrix (N=369 341). Incidence rate ratios (IRR) were computed by Poisson regression.

Results

During 186 million person-weeks of follow-up, we observed 2944 COVID-19 related hospital admissions in at-risk occupations and 559 in referents. Adjusted risk of such admission was elevated in several occupations within healthcare (including health care assistants, nurses, medical practitioners and laboratory technicians but not physiotherapists or midwives), social care (daycare assistants for children aged 4–7, and nursing aides in institutions and private homes, but not family daycare workers) and transportation (bus drivers, but not lorry drivers). Most IRR in these at-risk occupations were in the range of 1.5–3. Employees in education, retail sales and various service occupations seemed not to be at risk.

Conclusion

Employees in several occupations within and outside healthcare are at substantially increased risk of COVID-19. There is a need to revisit safety measures and precautions to mitigate viral transmission in the workplace during the current and forthcoming pandemics.

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Most cited references 42

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Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

Long H Nguyen, David A Drew, Mark S. Graham … (2020)

Summary Background Data for front-line health-care workers and risk of COVID-19 are limited. We sought to assess risk of COVID-19 among front-line health-care workers compared with the general community and the effect of personal protective equipment (PPE) on risk. Methods We did a prospective, observational cohort study in the UK and the USA of the general community, including front-line health-care workers, using self-reported data from the COVID Symptom Study smartphone application (app) from March 24 (UK) and March 29 (USA) to April 23, 2020. Participants were voluntary users of the app and at first use provided information on demographic factors (including age, sex, race or ethnic background, height and weight, and occupation) and medical history, and subsequently reported any COVID-19 symptoms. We used Cox proportional hazards modelling to estimate multivariate-adjusted hazard ratios (HRs) of our primary outcome, which was a positive COVID-19 test. The COVID Symptom Study app is registered with ClinicalTrials.gov, NCT04331509. Findings Among 2 035 395 community individuals and 99 795 front-line health-care workers, we recorded 5545 incident reports of a positive COVID-19 test over 34 435 272 person-days. Compared with the general community, front-line health-care workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11·61, 95% CI 10·93–12·33). To account for differences in testing frequency between front-line health-care workers and the general community and possible selection bias, an inverse probability-weighted model was used to adjust for the likelihood of receiving a COVID-19 test (adjusted HR 3·40, 95% CI 3·37–3·43). Secondary and post-hoc analyses suggested adequacy of PPE, clinical setting, and ethnic background were also important factors. Interpretation In the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds. Additional follow-up of these observational findings is needed. Funding Zoe Global, Wellcome Trust, Engineering and Physical Sciences Research Council, National Institutes of Health Research, UK Research and Innovation, Alzheimer's Society, National Institutes of Health, National Institute for Occupational Safety and Health, and Massachusetts Consortium on Pathogen Readiness.

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SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis

Muge Cevik, Matthew C. Tate, Ollie Lloyd … (2020)

Background Viral load kinetics and duration of viral shedding are important determinants for disease transmission. We aimed to characterise viral load dynamics, duration of viral RNA shedding, and viable virus shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in various body fluids, and to compare SARS-CoV-2, SARS-CoV, and Middle East respiratory syndrome coronavirus (MERS-CoV) viral dynamics. Methods In this systematic review and meta-analysis, we searched databases, including MEDLINE, Embase, Europe PubMed Central, medRxiv, and bioRxiv, and the grey literature, for research articles published between Jan 1, 2003, and June 6, 2020. We included case series (with five or more participants), cohort studies, and randomised controlled trials that reported SARS-CoV-2, SARS-CoV, or MERS-CoV infection, and reported viral load kinetics, duration of viral shedding, or viable virus. Two authors independently extracted data from published studies, or contacted authors to request data, and assessed study quality and risk of bias using the Joanna Briggs Institute Critical Appraisal Checklist tools. We calculated the mean duration of viral shedding and 95% CIs for every study included and applied the random-effects model to estimate a pooled effect size. We used a weighted meta-regression with an unrestricted maximum likelihood model to assess the effect of potential moderators on the pooled effect size. This study is registered with PROSPERO, CRD42020181914. Findings 79 studies (5340 individuals) on SARS-CoV-2, eight studies (1858 individuals) on SARS-CoV, and 11 studies (799 individuals) on MERS-CoV were included. Mean duration of SARS-CoV-2 RNA shedding was 17·0 days (95% CI 15·5–18·6; 43 studies, 3229 individuals) in upper respiratory tract, 14·6 days (9·3–20·0; seven studies, 260 individuals) in lower respiratory tract, 17·2 days (14·4–20·1; 13 studies, 586 individuals) in stool, and 16·6 days (3·6–29·7; two studies, 108 individuals) in serum samples. Maximum shedding duration was 83 days in the upper respiratory tract, 59 days in the lower respiratory tract, 126 days in stools, and 60 days in serum. Pooled mean SARS-CoV-2 shedding duration was positively associated with age (slope 0·304 [95% CI 0·115–0·493]; p=0·0016). No study detected live virus beyond day 9 of illness, despite persistently high viral loads, which were inferred from cycle threshold values. SARS-CoV-2 viral load in the upper respiratory tract appeared to peak in the first week of illness, whereas that of SARS-CoV peaked at days 10–14 and that of MERS-CoV peaked at days 7–10. Interpretation Although SARS-CoV-2 RNA shedding in respiratory and stool samples can be prolonged, duration of viable virus is relatively short-lived. SARS-CoV-2 titres in the upper respiratory tract peak in the first week of illness. Early case finding and isolation, and public education on the spectrum of illness and period of infectiousness are key to the effective containment of SARS-CoV-2. Funding None.

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Principles of confounder selection

Tyler J. VanderWeele (2019)

Selecting an appropriate set of confounders for which to control is critical for reliable causal inference. Recent theoretical and methodological developments have helped clarify a number of principles of confounder selection. When complete knowledge of a causal diagram relating all covariates to each other is available, graphical rules can be used to make decisions about covariate control. Unfortunately, such complete knowledge is often unavailable. This paper puts forward a practical approach to confounder selection decisions when the somewhat less stringent assumption is made that knowledge is available for each covariate whether it is a cause of the exposure, and whether it is a cause of the outcome. Based on recent theoretically justified developments in the causal inference literature, the following proposal is made for covariate control decisions: control for each covariate that is a cause of the exposure, or of the outcome, or of both; exclude from this set any variable known to be an instrumental variable; and include as a covariate any proxy for an unmeasured variable that is a common cause of both the exposure and the outcome. Various principles of confounder selection are then further related to statistical covariate selection methods.

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Author and article information

Journal

Journal ID (nlm-ta): Scand J Work Environ Health

Journal ID (iso-abbrev): Scand J Work Environ Health

Title: Scandinavian Journal of Work, Environment & Health

Publisher: Nordic Association of Occupational Safety and Health (Finland )

ISSN (Print): 0355-3140

ISSN (Electronic): 1795-990X

Publication date (Print): 1 January 2023

Publication date (Electronic preprint): 13 October 2022

Publication date (Electronic): 30 December 2022

Volume: 49

Issue: 1

Pages: 84-94

Affiliations

[1 ]Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark

[2 ]Department of Public Health, University of Copenhagen, Copenhagen, Denmark

[3 ]MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK

[4 ]Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

[5 ]Centre for occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden

[6 ]Netherlands Organization for Applied Scientific Research TNO, Department of Work Health Technology, Leiden, The Netherlands

[7 ]Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Århus, Denmark

[8 ]National Institute of Occupational Health (STAMI), Oslo, Norway

[9 ]Institute of Health and Society, University of Oslo, Oslo, Norway

[10 ]Department of Public Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark

[11 ]National Research Center for the Working Environment, Copenhagen, Denmark

[12 ]Finnish Institute of Occupational Health, Helsinki, Finland

[13 ]Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden

[14 ]Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa

[15 ]School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden

[16 ]Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden

[17 ]Division of Public Health, Kristianstad University, Kristianstad, Sweden

Author notes

Correspondence to: Jens Peter Bonde, Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospitals, Bispebjerg Bakke 23, DK-Copenhagen 2400 NV, Denmark. [E-mail: Jens.Peter.Ellekilde.Bonde@ 123456regionh.dk ]

Article

Publisher ID: SJWEH-49-84

DOI: 10.5271/sjweh.4063

PMC ID: 10549918

PubMed ID: 36228167

SO-VID: eb930e0f-e3dd-4444-bed5-c8b0bc264c6a

License:

This work is licensed under a Creative Commons Attribution 4.0 International License.

Occupational risk of COVID-19 related hospital admission in Denmark 2020–2021: a follow-up study

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Abstract

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Results

Conclusion

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Novel Coronavirus Disease COVID-19

Most cited references 42

Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis

Principles of confounder selection

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