Risk of Severe COVID-19 Among Workers and Their Household Members

Selden and Berdahl (2020) state that employment-related exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can endanger not only workers, but also their household members. Using prepandemic data, the researchers examined the prevalence of Centers for Disease Control and Prevention (CDC) risk factors for severe coronavirus disease 2019 (COVID-19). They then estimated how many adults at increased risk of severe COVID-19 held essential jobs and could not work at home (WAH) or who lived in households with such workers.

The researchers used deidentified data from the 2014-2017 Medical Expenditure Panel Survey (MEPS), an in-person household survey of the U.S. civilian noninstitutionalized population. The research was approved under an Agency for Healthcare Research and Quality Institutional Review Board protocol for MEPS research. The MEPS is the only nationally representative data set providing detailed information on health and employment for all household members. It draws participants from the National Health Interview Survey, with a 62.9% average response rate (National Health Interview Survey response rates averaged 74.0%).

Essential workers were identified using federal guidance.4 Because of the difficulty of determining which restaurant workers were essential, they classified the entire restaurant sector as nonessential. Ability to WAH was imputed from the American Time Use Survey.

Following CDC guidelines, persons at increased risk of severe illness had obesity (body mass index of 30 or higher; calculated as weight in kilograms divided by height in meters squared), age of 65 years or older, or any of the following treated conditions: diabetes, emphysema or other chronic obstructive pulmonary disease, kidney disease, cancer (other than nonmelanoma skin cancers), or coronary heart disease. To implement the CDC’s broader guidelines for possibly being at increased risk, they created a second variable that also included current smoking, treated asthma, or treated hypertension. The researchers implemented these definitions in MEPS by combining data that were self-reported by each adult with data reported for each adult by a single family respondent.

The MEPS sample contained 100,064 adult observations. Of the 157.3 million workers, 112.4 million (71.5%) were essential, and of these, only 31.2 million could WAH. Among all adults, 49.7% (123.2 million of 248.0 million) were at increased risk of severe COVID-19 using the main CDC guidelines (61.0% using the broader CDC guidelines). Although workers were at lower risk than nonworkers, 41.0% (46.1 million) and 54.4% (61.1 million) of the 112.4 million essential workers met the main and broader CDC increased-risk guidelines, respectively.

Reference: Selden TM and Berdahl TA. Risk of Severe COVID-19 Among Workers and Their Household Members. JAMA Intern Med. Published online Nov. 9, 2020. doi:10.1001/jamainternmed.2020.6249

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