Sociodemographic risk factors for coronavirus disease 2019 (COVID-19) infection among Massachusetts healthcare workers: A retrospective cohort study
Journal
Infection Control & Hospital Epidemiology
Date Issued
2021
DOI
10.1017/ice.2021.17
Abstract
Objective: To better understand coronavirus disease 2019 (COVID-19) transmission among healthcare workers (HCWs), we investigated
occupational and nonoccupational risk factors associated with cumulative COVID-19 incidence among a Massachusetts HCW cohort.
Design, setting, and participants: The retrospective cohort study included adult HCWs in a single healthcare system from March 9 to
June 3, 2020.
Methods: The SARS-CoV-2 nasopharyngeal RT-PCR results and demographics of the study participants were deidentified and extracted from
an established occupational health, COVID-19 database at the healthcare system. HCWs from each particular job grouping had been categorized
into frontline or nonfrontline workers. Incidence rate ratios (IRRs) and odds ratios (ORs) were used to compare subgroups after
excluding HCWs involved in early infection clusters before universal masking began. A sensitivity analysis was performed comparing jobs
with the greatest potential occupational risks with others.
Results: Of 5,177 HCWs, 152 (2.94%) were diagnosed with COVID-19. Affected HCWs resided in areas with higher community attack rates
(median, 1,755.2 vs 1,412.4 cases per 100,000; P < .001; multivariate-adjusted IRR, 1.89; 95% CI, 1.03–3.44 comparing fifth to first quintile of
community rates). After multivariate adjustment, African-American and Hispanic HCWs had higher incidence of COVID-19 than non-
Hispanic white HCWs (IRR, 2.78; 95% CI, 1.78–4.33; and IRR, 2.41, 95% CI, 1.42–4.07, respectively). After adjusting for race and residential
rates, frontline HCWs had a higher IRR (1.73, 95% CI, 1.16–2.54) than nonfrontline HCWs overall, but not within specific job categories nor
when comparing the highest risk jobs to others.
Conclusions: After universal masking was instituted, the strongest risk factors associated with HCW COVID-19 infection were residential
community infection rate and race.
occupational and nonoccupational risk factors associated with cumulative COVID-19 incidence among a Massachusetts HCW cohort.
Design, setting, and participants: The retrospective cohort study included adult HCWs in a single healthcare system from March 9 to
June 3, 2020.
Methods: The SARS-CoV-2 nasopharyngeal RT-PCR results and demographics of the study participants were deidentified and extracted from
an established occupational health, COVID-19 database at the healthcare system. HCWs from each particular job grouping had been categorized
into frontline or nonfrontline workers. Incidence rate ratios (IRRs) and odds ratios (ORs) were used to compare subgroups after
excluding HCWs involved in early infection clusters before universal masking began. A sensitivity analysis was performed comparing jobs
with the greatest potential occupational risks with others.
Results: Of 5,177 HCWs, 152 (2.94%) were diagnosed with COVID-19. Affected HCWs resided in areas with higher community attack rates
(median, 1,755.2 vs 1,412.4 cases per 100,000; P < .001; multivariate-adjusted IRR, 1.89; 95% CI, 1.03–3.44 comparing fifth to first quintile of
community rates). After multivariate adjustment, African-American and Hispanic HCWs had higher incidence of COVID-19 than non-
Hispanic white HCWs (IRR, 2.78; 95% CI, 1.78–4.33; and IRR, 2.41, 95% CI, 1.42–4.07, respectively). After adjusting for race and residential
rates, frontline HCWs had a higher IRR (1.73, 95% CI, 1.16–2.54) than nonfrontline HCWs overall, but not within specific job categories nor
when comparing the highest risk jobs to others.
Conclusions: After universal masking was instituted, the strongest risk factors associated with HCW COVID-19 infection were residential
community infection rate and race.
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