gms | German Medical Science

Introduction: In Germany, COVID-19 can be recognized as an occupational disease (Occupational Disease Number 3101, Berufskrankheit Nr. 3101) when the infection occurs at the workplace for 1. healthcare workers, 2. workers in the social sector, 3. laboratory workers, or 4. for occupations with a comparably high infection risk [1], [2]. To date, other occupational groups (4.) have not been eligible for an occupational disease recognition in Germany, but have been recognized as work accidents (e.g. meat packers). Studies on occupation and COVID-19 infection that cover a range of occupational groups and adjust for important confounders are lacking. This study aimed to estimate occupational risks of hospitalization with COVID-19 by taking into account sociodemographic factors and previous comorbidities.

Methods: We applied a case-cohort design using workers insured with one of Germany’s largest statutory health insurers as a data source for occupational and demographical information as well as for information on comorbidities. Cox regression models with denominator weights for cases and controls assessed relative risks of hospitalization with COVID-19 in 2020.

Results: The study consisted of 11,202 COVID-19 cases and 249,707 non-cases. After adjusting for age, sex, number of pre-existing comorbidities, and socioeconomic status, we found at least doubled risks for occupations in theology and church work (HR=3.05; 95% CI 1.93-4.82), occupations in healthcare (HR=2.74; 95% CI 2.46-3.05), bus and tram drivers (HR=2.46; 95% CI 2.04-2.97) as well as professional drivers in passenger transport (e.g. taxi drivers) (HR=2.00; 95% CI 1.59-2.51), and workers in meat processing (HR=2.16; 95% CI 1.57-2.98). Social workers, laboratory workers, occupations in personal care (e.g. hairdressers), occupations in housekeeping, occupations in property marketing and management and occupations in gastronomy all had statistically significantly increased risks compared to the reference population (administrative workers).

Conclusions: We identified occupations with increased risks for hospitalization with COVID-19. The recognition of occupational diseases in many countries is based on a doubling of risk, equivalent to the probability of causation due to the occupation being at least equal to 50%. For those having a doubled risk it can be assumed that COVID-19 diseases are predominantly occupationally related. By identifying high-risk occupations in non-healthcare professions, effective measures to prevent infections in the workplace can be developed, also in case of a future pandemic.

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.