Higher risk of COVID-19 hospitalization for unemployed: an analysis of 1,298,416 health insured individuals in Germany

Abstract

Background: Previous research on infectious disease has revealed that infection risk as well as the severity of diseases is related to income and poverty. In this study we investigate if unemployed persons have a higher risk to become hospitalized with a COVID-19 diagnosis compared with employed persons. Methods: We used routine data on hospitalizations in a study population of 1,298,416persons between the ages 18 and 65 who were enrolled in a German health insurance and who were active on the labour market (either employed or unemployed). Hospital diagnosis of COVID-19 (ICD-10-GM U07.1 and U07.2) were reported on a daily basis from 01.01.2020 to 04.06.2020. We studied if the rate of persons hospitalized with a COVID-19 diagnoses differed by employment situation. Logistic regression models comparing employed with short- and long-term unemployed were calculated adjusting for age and sex. Results: In total, we observed 1,311 persons who were hospitalized, corresponding to a rate of 100.98 cases per 100.000 in our study population. Rates varied between the groups in different employment situations with lowest rates for employed and highest for long-term unemployed. Odds ratio for a hospitalization was 1.84 (1.64 - 2.07) for long-term and 1.18 (0.75 - 1.85) for short-term unemployed compared with employed persons. Conclusion: The results are in line with earlier (mainly ecological) studies from the USA and Great Britain which found social inequalities in hospitalization risk. The fact that differences exist in Germany, a country with a universal health care system, indicates socioeconomic differences in the COVID-19 pandemic exists across countries.

Risk of psychological sequelae among coronavirus disease‐2019 survivors: A nationwide cohort study in South Korea

“…Moreover, individuals who were confirmed as COVID‐19‐positive have been reported to suffer from the stigma of COVID‐19 (Bagcchi, 2020; Singh & Subedi, 2020). A recent study reported that the COVID‐19 patients who were admitted to the hospital were at a higher risk of unemployment in Germany (Dragano et al, 2020). Unemployment is known to be a closely related factor to depression according to an epidemiological study (Dooley et al, 1994).…”

Predictors of Death Rate during the COVID-19 Pandemic

“…Geography was included as a known predictor of COVID-19 [ 22 ]. Similarly, demographics [ 23 , 24 ], population density [ 25 ], proportion of people aged 65 and older [ 21 ], economic considerations [ 26 ], population health status (comorbidities) [ 27 ], and political considerations [ 28 ] are also known as hypothetical factors that affect infection and death rates, although the reasons for the associations between individual variables and death rates are not fully understood [ 24 ]. We include hospital system characteristics to account for the possibility that lack of resources increase death rates [ 29 ].…”

Covid-19, social class and work experience in Germany: inequalities in work-related health and economic risks

“…Even though Covid-19 is a very recent phenomenon, research points to multiple inequalities in the effects of the pandemic on work-life. Research topics include home office (Fadinger and Schymik 2020), work-careconflicts (Kohlrausch and Zucco 2020), changes in working hours (Eurofound 2020), economic problems (Hövermann 2020;Adams-Prassl et al 2020) and health risks (Dragano et al 2020;ONS 2020). Concerning employees' experience of economic and health risks, it is important to note that previous research has focused on one of the two types of risks; no study has thus far addressed employees' views of both risks concurrently.…”

“…On the other hand, studies based on public health data, have shown that socio-economic position also impacts corona-related health risks (Bambra et al 2020). In Germany, unemployment is linked to higher risks for a Covid-19 hospitalization (Dragano et al 2020). For England and Wales, the office for national statistics reports considerable occupational inequalities in mortality rates (ONS 2020).…”