key: cord-1019030-nwafqs6l authors: Hawkins, Devan; Davis, Letitia; Kriebel, David title: COVID‐19 deaths by occupation, Massachusetts, March 1–July 31, 2020 date: 2021-02-01 journal: Am J Ind Med DOI: 10.1002/ajim.23227 sha: dfa38a44cc24e9f03ec0348a7f6138fc2c1f3edc doc_id: 1019030 cord_uid: nwafqs6l BACKGROUND: Exposure to COVID‐19 is more likely among certain occupations compared with others. This descriptive study seeks to explore occupational differences in mortality due to COVID‐19 among workers in Massachusetts. METHODS: Death certificates of those who died from COVID‐19 in Massachusetts between March 1 and July 31, 2020 were collected. Occupational information was coded and age‐adjusted mortality rates were calculated according to occupation. RESULTS: There were 555 deaths among MA residents of age 16–64, with usable occupation information, resulting in an age‐adjusted mortality rate of 16.4 per 100,000 workers. Workers in 11 occupational groups including healthcare support and transportation and material moving had mortality rates higher than that for workers overall. Hispanic and Black workers had age‐adjusted mortality rates more than four times higher than that for White workers overall and also had higher rates than Whites within high‐risk occupation groups. CONCLUSION: Efforts should be made to protect workers in high‐risk occupations identified in this report from COVID‐19 exposure. The workplace is likely an important venue for COVID-19 transmission. Different occupations face different risks for COVID-19 exposure due to the nature of the work performed. 1 These occupational exposures may be contributing to geographic, racial, and ethnic disparities in COVID-19 cases and deaths. [2] [3] [4] Previous research from the United Kingdom found that men in elementary occupations and women in caring and leisure occupations had significantly elevated mortality rates due to COVID-19 compared with all other workers. 5 In Sweden it was found that taxi and bus drivers had elevated mortality rates from COVID-19 compared with other workers 6 The objective of this study was to describe differences among occupations in mortality due to COVID-19 in the Massachusetts workforce as well as how occupational differences varied by race and ethnicity. Table S1 . Age-adjusted mortality rates were calculated by occupation, sex, and race/ethnicity using SAS (Version 9.3; SAS Institute). Age-standardization was performed using the COVID-19 mortality for all workers according to five age groups (16-24, 25-34, 35-44, 45-54, 55-64) . There were 737 deaths due to COVID-19 among Massachusetts residents 16-64 years old between March 1 and July 31, 2020. One hundred and twenty-two deaths were excluded because the death certificate indicated that the decedent was not working/retired (n = 69), a homemaker (48), a student, 4 or in the military. 1 An additional 60 deaths were excluded because of insufficient occupation information, resulting in 555 COVID-19 deaths. There were a total of 555 deaths identified among MA workers aged 16-64 due to COVID-19 between March 1 and July 31, 2020. The overall mortality rate for this population was 16.4 deaths/100,000 workers during the 5-month study period. As shown in Figure 1 , deaths increased rapidly in April and May and then declined in June and July. Workers in 11 major occupation groups had age-adjusted mortality rates higher than the rates for all workers: healthcare support; transportation and material moving; food preparation and serving; building and grounds cleaning and maintenance; production; construction and extraction; installation, maintenance, and repair; protective service; personal care and service; arts, design, entertainment, sports, and media; and community and social service ( Figure 2 ). Hispanic and Black workers had mortality rates more than four times higher than that for White workers (53.4 and 50.4, respectively vs. 10.7/100,000). In almost all instances when sufficient data by race/ethnicity were available, Hispanic and Black workers had higher mortality rates than White workers in the same occupation group. Within the occupation groups with the five highest rates, Hispanic and Black workers had substantially higher rates than White workers in the same occupation group. For example, Hispanic food preparation and serving workers had a rate eight times that of White food preparation and serving workers. Black healthcare support workers had a rate nearly three times higher than that of White healthcare support workers. White workers in high-risk occupation groups still had elevated rates compared with White workers overall. For example, the rate of White healthcare support workers was more than double that of all White workers (Table 1 ). Among a working-age population, there were wide disparities in mortality due to COVID-19 according to occupation. Occupation groups that would be expected to have frequent contact with ill people or close contact with the public, and jobs where working from home is impractical had particularly elevated mortality rates. Additionally, we identified Hispanic and Black workers as having mortality rates four times higher than that of White workers. Even within many high-risk occupation groups these elevated mortality rates persisted. Exposure to COVID-19 varies by occupation and this is likely to be an important contributor to the differences observed in this study. 1 Many of the occupations with elevated mortality rates are essential services or jobs which cannot be performed from home. 8, 9 Workers in some of these occupations may also be at increased risk of death if infected because they have less access to healthcare. A previous study examined the percentage of workers that did not have insurance according to occupation. Of the 11 occupation groups with elevated mortality rates in this study, 7 had higher a higher percentage of workers without insurance compared with the average for all workers. 10 Workers in high-risk occupations may also be more likely to have underlying comorbidities that increase the risk of dying of COVID- 19. 11 Healthcare support workers were identified as having the highest age-adjusted mortality rates in this study. This finding likely reflects the nature of the work being performed by healthcare support workers where exposure to infected patients would be common. However, among healthcare practitioners, mortality rates were not elevated. This finding may be due to the fact that healthcare practitioners likely have more of an ability to work from home compared with healthcare support workers. 12 These findings also suggest that occupational exposures may be an important contributing factor to well-documented racial and ethnic disparities in COVID-19 deaths. Some of these disparities may be due to Black and Hispanic workers being more likely to work in Male workers had nearly twice the mortality rate for COVID-19 as female workers. This difference was particularly stark for Hispanic, Black, and workers of other races and ethnicities. Although this finding of a higher risk of mortality among males compared with females is broadly consistent with previous research about differences in the risk of mortality due to COVID-19 by age and sex, 13, 14 reasons for these differences deserve particular attention. Additionally, the scale of the differences seems to be greater than in other studies that did not deal solely with working populations. Some of the differences identified here may be due to employment in higher-risk occupations. Due to the relatively small sample size analyzed here, the relationship between sex and occupation could not be further explored. Deaths were highest in April and May, the peak of the first pandemic surge in MA. Some of the deaths that occurred in April and May could be attributable to occupational exposures that occurred before the mid-March lockdown in MA and implementation of exposure controls because of the delay between initial exposure and death. The decline in later months likely reflects a combination of multiple factors including fewer workers-even those in essential jobs-actually going to the workplace in Phase 2 of the pandemic, 15 improved treatment for severe COVID cases, 16 access may contribute to racial and ethnic differences in the risk for COVID-19 infection. 22 The findings from this study identify occupations where these efforts are particularly urgent. Efforts to control the spread of COVID-19 in the workplace can both help to protect all workers and reduce health disparities. The authors declare that there are no conflicts of interest. John D. Meyer declares that he has no conflict of interest in the review and publication decision regarding this article. Devan Hawkins conceived the study, acquired data, performed initial analysis, and drafted the paper. Letitia Davis and David Kriebel suggested further analyses, produced tables and figures, and revised the manuscript. All authors approve this version of the manuscript and agree to be accountable for all aspects of the work. The peer review history for this article is available at https://publons. com/publon/10.1002/ajim.23227. The data in this report are publicly available data. It can be obtained by making a public data request to the Massachusetts Registry of Vital Records and Statistics. This project was considered exempt from review by the MCPHS University Institutional Review Board, because it was conducted with previously collected, deidentified data. http://orcid.org/0000-0002-7823-8153 Estimating the burden of United States workers exposed to infection or disease: a key factor in containing risk of COVID-19 infection Differential occupational risk for COVID-19 and other infection exposure according to race and ethnicity Racial Disparity in COVID-19 Deaths: Seeking Economic Roots with Census data Social determinants of COVID-19 in Massachusetts, United States: an ecological study Coronavirus (COVID-19) Related Deaths by Occupation, England and Wales: Deaths Registered up to and Including Deaths in the frontline: Occupation-specific COVID-19 mortality risks in Sweden National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluation and Field Studies, Surveillance Branch Many essential workers are in "lowprestige" jobs. Time to change our attitudes-and policies? Nonrelocatable occupations at increased risk during pandemics: United States Health insurance coverage by occupation among adults aged 18-64 years-17 States Prevalence of underlying medical conditions among selected essential critical infrastructure workers-behavioral risk factor surveillance system Work-at-Home Patterns by Occupation Sex differential in COVID-19 mortality varies markedly by age Sex differences in severity and mortality from COVID-19: are males more vulnerable? COVID-19 and Remote Work: An Early Look at US Data Office of the Attorney General. Workplace Health and Safety During COVID-19: A Resource Guide for Employees Interim 20-ID-02: update to the standardized surveillance case definition and national notification for 2019 novel coronavirus disease (COVID-19) GA: Council of State and Territorial Epidemiologists Guidance for Certifying Deaths due to Coronavirus Disease 2019 (COVID19) Disparities in COVID-19 testing and positivity in New York City Massachusetts Department of Public Health COVID-19 Dashboard-Dashboard of Public Health Indicators Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study COVID-19 deaths by occupation