Background: Information on U.S. COVID-19 mortality rates by occupation is limited. We aimed to characterize 2020 COVID-19 fatalities among working Californians to inform preventive strategies.Methods: We identified laboratory-confirmed COVID-19 fatalities with dates of death in 2020 by matching death certificates to the state’s COVID-19 case registry. Working status for decedents aged 18–64 years was determined from state employment records, death certificates, and case registry data and classified as “confirmed working,” “likely working,” or “not working.” We calculated age-adjusted overall and occupation-specific COVID-19 mortality rates using 2019 American Community Survey denominators.Results: COVID-19 accounted for 8,050 (9.9%) of 81,468 fatalities among Californians 18–64 years old. Of these decedents, 2,486 (30.9%) were matched to state employment records and classified as “confirmed working.” The remainder were classified as “likely working” (n = 4,121 [51.2%]) or “not working” (n = 1,443 [17.9%]) using death certificate and case registry data. Confirmed and likely working COVID-19 decedents were predominantly male (76.3%), Latino (68.7%), and foreign-born (59.6%), with high school or less education (67.9%); 7.8% were Black. The overall age-adjusted COVID-19 mortality rate was 30.0 per 100,000 workers (95% confidence interval [CI], 29.3–30.8). Workers in nine occupational groups had age-adjusted mortality rates higher than this overall rate, including those in farming (78.0; 95% CI, 68.7–88.2); material moving (77.8; 95% CI, 70.2–85.9); construction (62.4; 95% CI, 57.7–67.4); production (60.2; 95% CI, 55.7–65.0); and transportation (57.2; 95% CI, 52.2–62.5) occupations. While occupational differences in mortality were evident across demographic groups, mortality rates were three-fold higher for male compared with female workers and three- to seven-fold higher for Latino and Black workers compared with Asian and White workers.Conclusion: Californians in manual labor and in-person service occupations experienced disproportionate COVID-19 mortality, with the highest rates observed among male, Latino, and Black workers; these occupational group should be prioritized for prevention.

Little is known about occupational SARS-CoV-2 exposures and COVID-19 outcomes. We established a Doctor’s First Reports of Occupational Injury or Illness (DFR)-based surveillance system to study cases of work-related COVID-19 exposures and disease. The surveillance data included demographics, occupation, industry, exposure, and illness, details including hospitalization and lost work. We classified workers into ‘healthcare’, non-healthcare ‘public-facing’, or ‘other’ worker groups, and rural–urban commuting areas (RUCAs). We describe worker exposures and outcomes overall by worker group and RUCA. We analyzed 2848 COVID-19 DFRs representing workers in 22 detailed occupation groups and 19 industry groups. Most DFRs were for workers in metropolitan RUCAs (89%) and those in healthcare (42%) and public-facing (24%) worker groups. While DFRs were from 382 unique worksites, 52% were from four hospitals and one prison. Among 1063 DFRs with a suspected exposure, 73% suspected exposure to a patient or client. Few DFRs indicated hospitalization (3.9%); however, the proportion hospitalized was higher among nonmetropolitan (7.4%) and public-facing (6.7%) workers. While 56% of DFRs indicated some lost work time, the proportion was highest among public-facing (80%) workers. Healthcare and prison workers were the majority of reported occupational COVID-19 exposures and illnesses. The risk of COVID-19 hospitalization and lost work may be highest among nonmetropolitan and public-facing workers.

Limited data exist on COVID-19’s mental health impact on non-healthcare workers. We estimated the prevalence of depressed mood and suicidal ideation experienced in the past year among California workers and assessed whether the prevalence changed during the COVID-19 pandemic. We analyzed 2013–2020 California Health Interview Survey data using survey-weighted methods to assess the change in the prevalence of depressed mood and suicidal ideation from 2019 to 2020 for working adults by demographics and occupational groups. We used trend-adjusted quasi-Poisson regressions and report rate ratios (RR), comparing the prevalence of outcomes during 2020 to the pre-pandemic period (2013–2019). We identified priority occupation groups with a higher-than-average outcome prevalence in 2020 and rate increases after adjusting for pre-pandemic trends. Our analysis included 168,768 respondents, of which 65% were workers. Production and service workers were the priority occupation groups for depressed mood (RR: 1.46, CI: 1.1–1.9; RR: 1.23, CI: 1.1–1.4) and suicidal ideation (RR: 1.86, CI: 1.0–3.6; RR: 1.47, CI: 1.1–1.9). Workers aged 45–65 years experienced over a 30% relative increase in both outcomes from 2019 to 2020. Depressed mood and suicidal ideation in the past year increased for production, service, and older workers during the pandemic. These groups should be considered for mental health interventions.

To assess changes in COVID-19 mortality rate and disparities over variants/waves by industry groups. We used a population-based retrospective cohort study approach. We identified COVID-19 deaths that occurred between January 2020 and May 2022 among the California working population age 18-64 years using death certificates. We used the Current Population Survey to derive estimates for working-age Californians at risk of COVID-19 mortality. The waves in deaths were categorized as Wave 1: March -June 2020, Wave 2: July -November 2020, Wave 3/Epsilon & Alpha variants: December 2020-May 2021, Wave 4/Delta variant: June 2021-January 2022, and Wave 5/Omicron variant: February -May 2022. Poisson regression was used to generate wave-specific mortality rate ratios (MRR). We assessed significance of change in MRR for each industry across waves by including an interaction term between industry and wave in different models. In all waves of the pandemic, Healthcare (MRR_{wave 1}=2.49, 95%CI (1.78 - 3.49)), Other Services (MRR_{wave 4}=2.89, 95%CI (2.39 - 3.50)), Manufacturing (MRR_{wave 2}=2.01, 95%CI (1.59 - 2.53)), Transportation (MRR_{wave 4}=2.64, 95%CI (2.20 - 3.17)), and Retail Trade industries (MRR_{wave 5}=1.87, 95%CI (1.48 - 2.36)) had higher mortality rates than the Professional, Scientific, and Technical industry which had one of the lowest mortality rates. Healthcare industry had the highest relative rate earlier in the pandemic, which diminished over time while Other Services, Utilities and Accommodation and Food Services industries had substantial increases in mortality rate ratios in later waves. Industries that consistently had disproportionate burden of the COVID-19 mortality may have benefitted from protections that consider workers' increased exposure and vulnerability to severe outcomes.