Risk factors associated with SARS-CoV-2 infection in a multiethnic cohort of United Kingdom healthcare workers (UK-REACH): A cross-sectional analysis

Abstract

Background Healthcare workers (HCWs), particularly those from ethnic minority groups, have been shown to be at disproportionately higher risk of infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) compared to the general population. However, there is insufficient evidence on how demographic and occupational factors influence infection risk among ethnic minority HCWs. Methods and findings We conducted a cross-sectional analysis using data from the baseline questionnaire of the United Kingdom Research study into Ethnicity and Coronavirus Disease 2019 (COVID-19) Outcomes in Healthcare workers (UK-REACH) cohort study, administered between December 2020 and March 2021. We used logistic regression to examine associations of demographic, household, and occupational risk factors with SARS-CoV-2 infection (defined by polymerase chain reaction (PCR), serology, or suspected COVID-19) in a diverse group of HCWs. The primary exposure of interest was self-reported ethnicity. Among 10,772 HCWs who worked during the first UK national lockdown in March 2020, the median age was 45 (interquartile range [IQR] 35 to 54), 75.1% were female and 29.6% were from ethnic minority groups. A total of 2,496 (23.2%) reported previous SARS-CoV-2 infection. The fully adjusted model contained the following dependent variables: demographic factors (age, sex, ethnicity, migration status, deprivation, religiosity), household factors (living with key workers, shared spaces in accommodation, number of people in household), health factors (presence/absence of diabetes or immunosuppression, smoking history, shielding status, SARS-CoV-2 vaccination status), the extent of social mixing outside of the household, and occupational factors (job role, the area in which a participant worked, use of public transport to work, exposure to confirmed suspected COVID-19 patients, personal protective equipment [PPE] access, aerosol generating procedure exposure, night shift pattern, and the UK region of workplace). After adjustment, demographic and household factors associated with increased odds of infection included younger age, living with other key workers, and higher religiosity. Important occupational risk factors associated with increased odds of infection included attending to a higher number of COVID-19 positive patients (aOR 2.59, 95% CI 2.11 to 3.18 for ≥21 patients per week versus none), working in a nursing or midwifery role (1.30, 1.11 to 1.53, compared to doctors), reporting a lack of access to PPE (1.29, 1.17 to 1.43), and working in an ambulance (2.00, 1.56 to 2.58) or hospital inpatient setting (1.55, 1.38 to 1.75). Those who worked in intensive care units were less likely to have been infected (0.76, 0.64 to 0.92) than those who did not. Black HCWs were more likely to have been infected than their White colleagues, an effect which attenuated after adjustment for other known risk factors. This study is limited by self-selection bias and the cross sectional nature of the study means we cannot infer the direction of causality. Conclusions We identified key sociodemographic and occupational risk factors associated with SARS-CoV-2 infection among UK HCWs, and have determined factors that might contribute to a disproportionate odds of infection in HCWs from Black ethnic groups. These findings demonstrate the importance of social and occupational factors in driving ethnic disparities in COVID-19 outcomes, and should inform policies, including targeted vaccination strategies and risk assessments aimed at protecting HCWs in future waves of the COVID-19 pandemic. Trial registration The study was prospectively registered at ISRCTN (reference number: ISRCTN11811602).

Hesitancy for receiving regular SARS-CoV-2 vaccination in UK healthcare workers: a cross-sectional analysis from the UK-REACH study

“…These findings may be due to a lower perceived risk of infection or severe illness due to younger age or having previously suffered minor symptoms from COVID-19 (although, in our study, we did not find an association between perceived risk of hospitalisation with COVID-19 and hesitancy). Emerging evidence suggests that re-infection risk increases with time, especially with omicron and its subvariants [ 22 , 23 ]. Whilst reinfection does not necessarily result in severe disease, reinfected HCWs may emit large quantities of virus for limited periods of time [ 34 ].…”

“…Recruitment is described in detail in the study protocol [ 19 ] and in previous publications [ 20 – 22 ]. In brief, participating UK healthcare regulators (for a list of regulators, see Additional file 1 : Supplementary text) sent emails to their registrants informing them of the study.…”

Antibody correlates of protection from SARS-CoV-2 reinfection prior to vaccination: A nested case-control within the SIREN study

“…29 Pre-reinfection LV-N and PV-N titres were significantly lower in cases than controls, supporting the mounting evidence that neutralising activity is critical for protection against SARS-CoV-2 infection. [11][12][13]30 It is know that titres and longevity of nAb are directly associated with clinical presentation of the primary COVID-19 episode, given asymptomatic SARS-CoV-2 infections induce lower levels and a more rapid decline of nAb titres over time when compared to moderate or severe infection. [31][32][33] However, we were unable to investigate this here as both groups in our study overwhelmingly reported mild or asymptomatic primary infections and none were hospitalised.…”

“…The absence of a suitable antibody response after first infection, influenced by epidemiological factors such as severity of infection and immunosuppression, and decreasing neutralising antibody (nAb) titres over time were associated with SARS-CoV-2 reinfection. [10][11][12][13] nAb titres to specific variants may be more relevant for sterilising immunity than total IgG or binding antibody levels, thus a more accurate correlate of protection against infection. 14,15 When comparing individuals who experienced reinfection and those after recover from primary infection (convalescent), no difference in antibody levels within weeks after reinfection were found.…”

Risk assessment and strategic action are required to protect at risk minority groups of healthcare workers in future COVID-19 pandemics

“…The augmented burden of COVID-2019 infection on HCWs and their families, specifically those from ethnic minority groups, has been reported, raising concerns about the protection of those at highest risk 1–3. Research on the interdependency of ethnicity with other essential risk factors, such as occupation has been scant 1 3 4.…”