Excess mortality associated with the COVID-19 pandemic among Californians 18-65 years of age, by occupational sector and occupation: March through November 2020

Abstract

Background: Though SARS-CoV-2 outbreaks have been documented in occupational settings and in-person essential work has been suspected as a risk factor for COVID-19, occupational differences in excess mortality have, to date, not been examined. Such information could point to opportunities for intervention, such as vaccine prioritization or regulations to enforce safer work environments.

Methods and findings: Using autoregressive integrated moving average models and California Department of Public Health data representing 356,188 decedents 18-65 years of age who died between January 1, 2016 and November 30, 2020, we estimated pandemic-related excess mortality by occupational sector and occupation, with additional stratification of the sector analysis by race/ethnicity. During these first 9 months of the COVID-19 pandemic, working-age adults experienced 11,628 more deaths than expected, corresponding to 22% relative excess and 46 excess deaths per 100,000 living individuals. Sectors with the highest relative and per-capita excess mortality were food/agriculture (39% relative excess; 75 excess deaths per 100,000), transportation/logistics (31%; 91 per 100,000), manufacturing (24%; 61 per 100,000), and facilities (23%; 83 per 100,000). Across racial and ethnic groups, Latino working-age Californians experienced the highest relative excess mortality (37%) with the highest excess mortality among Latino workers in food and agriculture (59%; 97 per 100,000). Black working-age Californians had the highest per-capita excess mortality (110 per 100,000), with relative excess mortality highest among transportation/logistics workers (36%). Asian working-age Californians had lower excess mortality overall, but notable relative excess mortality among health/emergency workers (37%), while White Californians had high per-capita excess deaths among facilities workers (70 per 100,000).

Conclusions: Certain occupational sectors are associated with high excess mortality during the pandemic, particularly among racial and ethnic groups also disproportionately affected by COVID-19. In-person essential work is a likely venue of transmission of coronavirus infection and must be addressed through vaccination and strict enforcement of health orders in workplace settings.

Fig 1. Relative excess mortality among Californians 18–65 years of age, March through November 2020.

The dashed vertical lines separate the first 3 quarters of the first year of the COVID-19 pandemic. The quarters roughly correspond to major policy decisions, after accounting for lags from policy decisions to infection to death. The first quarter corresponds to a period of sheltering in place, the second quarter corresponds to a period of reopening, and the third quarter corresponds to a period of business closures.

Fig 2. Relative excess mortality among Californians 18–65 years of age, by occupational sector, March through November 2020.

The dashed vertical lines separate the first 3 quarters of the first year of the COVID-19 pandemic. The quarters roughly correspond to major policy decisions, after accounting for lags from policy decisions to infection to death. The first quarter corresponds to a period of sheltering in place, the second quarter corresponds to a period of reopening, and the third quarter corresponds to a period of business closures.