Occupational differences in COVID-19 hospital admission and mortality risks between women and men in Scotland: a population-based study using linked administrative data

OBJECTIVES: Occupations vary with respect to workplace factors that influence exposure to COVID-19, such as ventilation, social contacts and protective equipment. Variations between women and men may arise because they have different occupational roles or behavioural responses. We estimated occupational differences in COVID-19 hospital admission and mortality risks by sex.

METHODS: We combined (1) individual-level data from 2011 Census with (2) health records and (3) household-level information from residential identifiers, using a Scottish cohort of 1.7 million adults aged 40-64 years between 1 March 2020 and 31 January 2021. We estimated age-standardised COVID-19 hospital admission and mortality rates, stratified by sex and occupation. Cox proportional hazards models were adjusted for pre-pandemic health and occupational exposure factors, including interaction effects between occupation and sex.

RESULTS: Women had lower age-standardised COVID-19 hospital admission and mortality rates than men. Among women, adjusted death risks were lowest for health professionals, and those in associate professional and technical occupations (paramedics and medical technicians), with the latter supported by results from the interaction model. Among men, elevated adjusted admission and death risks were observed for large vehicle and taxi drivers. Additionally, admission risks remained high among men in caring personal services (including home and care workers), while elevated risks were observed among women in customer service occupations (call centre operators) and process, plant and machine operative roles (assemblers and sorters).

CONCLUSIONS: Occupational differences in COVID-19 hospital admission and mortality risks between women and men highlight the need to account for sex differences when developing interventions to reduce infections among vulnerable occupational groups.