Occupational risks for infection with influenza A and B: a national case-control study covering 1 July 2006-31 December 2019.

OBJECTIVES: We investigated whether crowded workplaces, sharing surfaces and exposure to infections were factors associated with a positive test for influenza virus. METHODS: We studied 11 300 cases with a positive test for influenza A and 3671 cases of influenza B from Swedish registry of communicable diseases. Six controls for each case were selected from the population registry, with each control being assigned the index date of their corresponding case. We linked job histories to job-exposure matrices (JEMs), to assess different transmission dimensions of influenza and risks for different occupations compared with occupations that the JEM classifies as low exposed. We used adjusted conditional logistic analyses to estimate the ORs for influenza with 95% CI. RESULTS: The highest odds were for influenza were: regular contact with infected patients (OR 1.64, 95% CI 1.54 to 1.73); never maintained social distance (OR 1.51, 95% CI 1.43 to 1.59); frequently sharing materials/surfaces with the general public (OR 1.41, 95% CI 1.34 to 1.48); close physical proximity (OR 1.54, 95% CI 1.45 to 1.62) and high exposure to diseases or infections (OR 1.54, 95% CI 1.44 to 1.64). There were small differences between influenza A and influenza B. The five occupations with the highest odds as compared with low exposed occupations were: primary care physicians, protective service workers, elementary workers, medical and laboratory technicians, and taxi drivers. CONCLUSIONS: Contact with infected patients, low social distance and sharing surfaces are dimensions that increase risk for influenza A and B. Further safety measures are needed to diminish viral transmission in these contexts.

Risk for hospitalization due to COVID-19 in relation to occupational exposures as estimated by two different job-exposure matrices

IntroductionThe COVID-19 pandemic has profoundly challenged occupational safety and health. We assessed risk for hospitalization for COVID-19 in relation to potential routes and degree of occupational exposure.Material and MethodsThe study includes 1 105 042 subjects in the county of Stockholm of age 18–64 years, with an occupational code, followed regarding hospitalization from 1 March 2020 until 15 September 2022. We used two different job-exposure matrices (JEMs), based on survey data (Office for National Statistics 2020) and expert assessment (Oude Hengel et al 2022, module for Denmark), respectively. Hazard ratios (HRs) and 95% confidence intervals (CI) were obtained with Cox´s proportional hazards models. Fully adjusted models included age, sex, vaccination (time-dependent), household size, living space per person, income quintile, proportion of smokers in the occupation, and country of birth.ResultsWe observed 6523 hospitalizations with COVID-19 as the main diagnosis. HRs increased incrementally with the exposure dimensions in both JEMs and were increased already from the low-exposed categories.The fully adjusted HRs (95% CI) for the highest exposure category were for the survey-based JEM: Closeness to other people (very close, almost touching): 1.51 (1.42–1.59);Exposure to other people´s diseases (daily): 1.41 (1.33–1.50). Similarly, we found for the expert-based JEM: Number of co-workers in close vicinity (>30/day): 1.47 (1.39–1.57);Nature of contact with other people (regular contact with COVID-19 patients): 1.51 (1.40–1.63);Location of work (>4h/day indoors): 1.25 (1.19–1.31);Inability to keep social distancing (can never maintain >1m): 1.42 (1.33–1.51).ConclusionsDimensions of potential occupational exposure in both the survey- and expert-based JEMs were consistently associated with hospitalization for COVID-19 and may thus guide risk assessment. Increased risks observed already in the lower exposure categories indicate a need for enhanced preventive measures also in those settings.

Low-quality employment trajectories and risk of common mental disorders, substance use disorders and suicide attempt: a longitudinal study of the Swedish workforce.

OBJECTIVE: High-quality longitudinal evidence exploring the mental health risk associated with low-quality employment trajectories is scarce. We therefore aimed to investigate the risk of being diagnosed with common mental disorders, substance use disorders, or suicide attempt according to low-quality employment trajectories. METHODS: A longitudinal register-study based on the working population of Sweden (N=2 743 764). Employment trajectories (2005-2009) characterized by employment quality and pattern (constancy, fluctuation, mobility) were created. Hazard ratios (HR) were estimated using Cox proportional hazards regression models for first incidence (2010-2017) diagnosis of common mental disorders, substance use disorders and suicide attempt as dependent on employment trajectories. RESULTS: We identified 21 employment trajectories, 10 of which were low quality (21%). With the exception of constant solo self-employment, there was an increased risk of common mental disorders (HR 1.07-1.62) and substance use disorders (HR 1.05-2.19) for all low-quality trajectories. Constant solo self-employment increased the risk for substance use disorders among women, while it reduced the risk of both disorders for men. Half of the low-quality trajectories were associated with a risk increase of suicide attempt (HR 1.08-1.76). CONCLUSIONS: Low-quality employment trajectories represent risk factors for mental disorders and suicide attempt in Sweden, and there might be differential effects according to sex - especially in terms of self-employment. Policies ensuring and maintaining high-quality employment characteristics over time are imperative. Similar prospective studies are needed, also in other contexts, which cover the effects of the Covid-19 pandemic as well as the mechanisms linking employment trajectories with mental health.