Socioeconomic and Demographic Risk Factors for SARS-CoV-2 Seropositivity Among Healthcare Workers in a UK Hospital: A Prospective Cohort Study

Abstract

Background: To protect healthcare workers (HCWs) from the consequences of disease due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is necessary to understand the risk factors that drive exposure and infection within hospitals. Insufficient consideration of key socioeconomic variables is a limitation of existing studies that can lead to bias and residual confounding of proposed risk factors for infection.

Methods: The Co-STARs study prospectively enrolled 3679 HCWs between April 2020 and September 2020. We used multivariate logistic regression to comprehensively characterize the demographic, occupational, socioeconomic, and environmental risk factors for SARS-CoV-2 seropositivity.

Results: After adjusting for key confounders, relative household overcrowding (odds ratio [OR], 1.4 [95% confidence interval {CI}, 1.1-1.9]; P = .006), Black, Black British, Caribbean, or African ethnicity (OR, 1.7 [95% CI, 1.2-2.3]; P = .003), increasing age (ages 50-60 years: OR, 1.8 [95% CI, 1.3-2.4]; P < .001), lack of access to sick pay (OR, 1.8 [95% CI, 1.3-2.4]; P < .001).

Conclusions: Socioeconomic and demographic factors outside the hospital were the main drivers of infection and exposure to SARS-CoV-2 during the first wave of the pandemic in an urban pediatric referral hospital. Overcrowding and out-of-hospital SARS-CoV-2 contact are less amenable to intervention. However, lack of access to sick pay among externally contracted staff is more easily rectifiable. Our findings suggest that providing easier access to sick pay would lead to a decrease in SARS-CoV-2 transmission and potentially that of other infectious diseases in hospital settings.

Clinical trials registration: NCT04380896.

Keywords: SARS-CoV-2; ethnicity; healthcare workers; risk factors; socioeconomic status.

Graphical Abstract

This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/the-socio-economic-and-demographic-risk-factors-for-sars-cov-2-seropositivity-among-healthcare-workers-in-a-uk-hospital-a-prospective-cohort-study/update

Figure 1.

Risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity among healthcare workers (HCWs). Risk of SARS-CoV-2 seropositivity among HCWs was estimated using univariate and multivariate logistic regression model. Points show the best estimate of the odds ratio (OR), while error bars represent the 95% confidence interval (CI) for the estimate OR. Bold indicates whether the OR is higher than the reference group (bold) or lower (gray). Statistical significance of the estimated ORs is presented next to the CI bars. *P < .05; **p<0.01; ***P < .001. Abbreviations: AHPs, allied health professionals; COVID-19, coronavirus disease 2019; ICT, Information Computing Technology.