Risk for Severe COVID-19 Illness Among Health Care Workers Who Work Directly with Patients
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J Gen Intern Med DOI: 10.1007/s11606-020-05992-y © Society of General Internal Medicine 2020
INTRODUCTION
A recent study from the Centers for Disease Control found that health care workers in the USA accounted for 19% of confirmed COVID-19 cases with information on occupation.1 At the same time, evidence is mounting that pre-existing conditions such as cardiovascular disease, diabetes, hypertension, and obesity, as well as older age, are associated with a higher risk of hospitalization, admission to an intensive care unit, and death among those with COVID-19.2 Health care workers who have direct contact with patients not only have an increased likelihood of being exposed to COVID-19, but those who are older or who have high-risk comorbidities are at particular risk of adverse COVID-19 outcomes. In the USA, 8.8% of physicians and 3.8% of registered nurses are aged ≥ 65 years.3 The objective of this study is to estimate the prevalence of high-risk comorbidities and older age for five types of health care workers, focusing on those who have direct contact with patients. The study also examines the sociodemographic characteristics of health care workers who are at higher risk for adverse COVID-19 outcomes.
METHODS
This study used pooled data on adults aged ≥ 18 years from the 2017 and 2018 National Health Interview Surveys (NHIS) (n = 52,159). The NHIS are nationally representative of the noninstitutionalized civilian population. A subsample was created of individuals who reported physical or hands-on contact with patients as part of their routine work and whose occupation was health care practitioner or technician (Standard Occupational Classification (SOC) code 29) or health care support (SOC code 31) (n = 1814).4 Practitioner and technician occupation categories were further defined by the entry level education required for the occupation (see Tables 1 and 2).5 COVID-19 high-risk comorbidity variables available from the NHIS were BMI ≥ 40, cancer in the past 3 years, cardiovascular disease, chronic lung disease or an asthma attack in Received May 22, 2020 Accepted June 12, 2020
the past year, current smoker, diabetes, kidney disease, and liver disease.2 Direct patient care health care workers were categorized as being at higher risk of adverse COVID-19 outcomes (“higher-risk health care workers”) if they had ≥ 1 high-risk comorbidity or if they were aged ≥ 65 years (n = 745). Descriptive statistics were calculated and Pearson design–based F-tests were used to determine whether percentages differed significantly across occupation categories. All estimates were weighted and accounted for the NHIS complex sampling design.
RESULTS
Of the 3.8% of US adults who worked directly with patients as health care workers, 38.6% were higher risk. Among direct patient care health care workers, the prevalence of high-risk comorbidities, older age, and higher-risk status differed significantly across occupation categories (Table 1). Among the subsample of higher-risk health care workers, 67.5% had 1 high-risk comorbidity, 28.3
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