COVID-19 Pandemic
The Role of Workplace Presence in Racial Disparities in COVID-19 Mortality During the Pandemic: A Mediation Analysis Elisabeth Gebreegziabher* Elisabeth Gebreegziabher Charsey Porse Gar-Wei Lee Matthew Frederick Kristin J. Cummings Ximena Vergara
Objective: To examine the relationship between being black, indigenous, and other people of color, including Latino origin (BIPOC) and presence at workplace, the effect of physical presence on COVID-19 mortality and whether and to what extent racial disparities in COVID-19 mortality were mediated through presence at the workplace.
Methods: Using a case-control study design, we identified all COVID-19 deaths in California (CA) through linkage to the CA COVID-19 registry, as well as non-COVID-19 deaths between January 2020 and March 2021, prior to the widespread availability of vaccines. We included decedents who were aged 18-64 years and confirmed to be working through Employment Development Department (EDD) records. We assigned occupations to in-person presence or not based on an in-house job-exposure matrix. The relationships between BIPOC status, presence at work, and death from a COVID-19 cause were assessed using logistic regression, adjusting for key demographics, while CAUSALMED in SAS was used for mediation analysis.
Results: Compared to non-Hispanic white decedents, BIPOC decedents had 39% (95%CI: 30–49%) higher odds of being present at work and 4.34 (95%CI: 3.93-4.79) times the odds of dying from COVID-19. Workplace presence increased the odds of dying from COVID-19 by 22% (95%CI: 11-33%). However, the effect of being BIPOC on dying from COVID-19 was predominantly through direct effect (NDE: OR=4.29, 95%CI: 3.87-4.73) and not mediated by the indirect path through presence (NIE: OR=1.01, 95%CI: 1.0-1.02).
Conclusion: BIPOC individuals were overrepresented in occupations requiring physical presence and were disproportionately affected by COVID-19 mortality. While workplace presence increased the risk of death from COVID-19, we did not detect a mediation effect of this presence in the effect of being BIPOC on COVID-19 death. Other social determinants may have a larger role in racial disparities in COVID-19 death. The workplace remains an important focal point for transmission interruption of communicable diseases.