Relationship between financial distress and mistreatment of workers regarding the COVID-19 prevention measures: A 1-year prospective cohort study.

OBJECTIVE: A substantial number of workers' experience mistreatment in the workplace, impacting workers' health and companies' functioning. Vulnerability of those with lower income has been reported, yet little is known about mistreatment during COVID-19. This study aims to examine whether workers in financial distress are particularly prone to mistreatment at the workplace with reference to pandemic-related infection prevention measures. METHODS: An internet-based, year-long prospective cohort study was conducted from 2020 to 2021. Participants were recruited from workers aged 20 and 65 years and currently employed at baseline. In total, 27 036 were included in the analysis and 18 170 responded to the follow-up survey. The odds ratio (OR) of mistreatment at the workplace regarding COVID-19 associated with the financial condition at baseline was estimated using multilevel logistic regression analysis nested by participant residence. RESULTS: Compared with workers in a comfortable financial condition, those under financial stress showed significantly higher ORs of mistreatment (age- and sex-adjusted model: 2.08, 95% confidence interval [CI] 1.75-2.47, P < .001, model adjusted for socioeconomic factors: 2.14, 95% CI 1.79-2.55, P < .001). CONCLUSION: Workers in financial distress were shown to be vulnerable to mistreatment at work regarding infection prevention measures in the COVID-19 pandemic, underscoring a double burden of poverty and mistreatment. The perspective of vulnerable groups needs to be taken into account when implementing countermeasures against emerging infectious diseases, such as COVID-19. As unfair treatment in the workplace might distort vulnerable employees' reactions to infection control (e.g., hiding infection), financial deprivation should be considered a public health issue.

Evaluation of workplace infection prevention and control measures for COVID-19: A prospective cohort study in Japan.

Background: Encouraging the implementation of infection prevention and control (IPC) measures has been necessary to prevent workplace infections caused by the coronavirus disease 2019 (COVID-19). However, the effectiveness of these measures in reducing infections has not been thoroughly evaluated. We evaluated employees' COVID-19 infection rates in relation to the implementation of IPC measures at their workplaces to identify effective workplace measures. Methods: This prospective cohort study was conducted between December 2020 and December 2021 using Internet-based self-assessment questionnaires, with 11,982 participants included from the baseline. To estimate whether implementing workplace IPC measures was associated with COVID-19 incidence rates among participants, we estimated multivariate-adjusted relative risk (RR) using a log-binomial model. Results: After adjusting for sex, age, education, household members, occupation-related factors, and personal preventive behaviors, requesting ill employees to refrain from going to work showed significantly lower COVID-19 infection rates than not requesting it (RR: 0.56, 95% CI: 0.34-0.91, p = 0.019). Conclusions: Employees restricted from reporting to work when ill had significantly lower COVID-19 infection rates than those who did not follow this measure. The results indicated that not coming to work when ill was effective in reducing COVID-19 infections at the workplace. We suggest that companies proactively adopt this policy and encourage their employees to comply with it.

Association between COVID-19 infection rates by region and implementation of non-pharmaceutical interventions: a cross-sectional study in Japan.

BACKGROUND: During a pandemic, non-pharmaceutical interventions (NPIs) play an important role in protecting oneself and others from infection. There are large regional differences in COVID-19 infection rates in Japan. We hypothesized that the local infection incidence may affect adherence to individual NPIs. METHODS: This cross-sectional study was conducted online among full-time workers in Japan in December 2020. The questionnaire asked the respondents to identify their habits regarding seven common NPIs (wearing masks, washing hands after the bathroom, disinfecting hands when entering indoors, gargling when returning home, ventilating the room, disinfecting or washing hands after touching frequently touched surfaces, carrying alcohol sanitizers when outdoors). RESULTS: A total of 27 036 participants were analyzed. Compared with the region with the lowest infection rate, five of the seven NPIs showed statistically significant trends across regional infection levels, the two exceptions being wearing masks and washing hands after the bathroom. Multivariate adjustment did not change these trends. CONCLUSIONS: This study found that NPIs were more prevalent in regions with higher incidence rates of COVID-19 in Japanese workers. The findings suggest that the implementation of NPIs was influenced not only by personal attributes but also by contextual effects of the local infection level.

Factors associated with acceptance of a digital contact tracing application for COVID-19 in the Japanese working-age population.

The working-age population is at the epicenter of coronavirus disease 2019 (COVID-19) infections. Therefore, it is important to increase the acceptance of digital contact tracing apps in this population. Contact-Confirming Application (COCOA) is the only digital contact tracing app in Japan. This study aimed to determine factors associated with acceptance of the COCOA for COVID-19 in the Japanese working-age population. A cross-sectional study was performed for 27,036 full-time workers registered with an internet survey company during December 2020 in Japan. Factors associated with COCOA adoption were evaluated by multivariate logistic regression analysis. The rate of downloading the COCOA was 25.1%. The COCOA was more likely to be accepted by people with married status, university graduation or above, higher income, and occupations involving desk work. Fear of COVID-19 transmission, wearing a mask, using hand disinfection, willingness to be vaccinated against COVID-19, and presence of an acquaintance infected with COVID-19 were also associated with a greater likelihood of adopting the app. The rate of downloading the COCOA in Japan was not very high. The present findings have important implications for widespread adoption of digital contact tracing apps in working-age populations in Japan and elsewhere.

The effects of telecommuting and family cohabiting situation on psychological distress in Japanese workers during the COVID-19 pandemic: A cross-sectional study.

OBJECTIVE: This study aimed to determine whether telecommuting's impact on psychological distress differed depending on the status of workers' cohabiting family members during the COVID-19 pandemic. METHODS: We collected data from 33 302 workers in Japan through an Internet survey, and included 27 036 valid responses in the analysis. The survey included items on family cohabitation and telecommuting status during the COVID-19 pandemic. We assessed workers' psychological distress using the Kessler 6. RESULTS: The psychological distress odds ratios (ORs) were higher for participants who lived with family members requiring care (OR = 1.38, P < .001), and lower for participants living with preschool children (OR = 0.77, P < .001) or a spouse (OR = 0.80, P < .001). Furthermore, odds ratios were higher for participants who worked from home and lived with family members requiring care or preschool children (OR = 1.52, P = .002; OR = 1.28, P = .028). Stratified by the presence or absence of family members living with them, psychological distress was higher for telecommuters with family members requiring care, preschool children, or elementary school children. CONCLUSION: The association between telecommuting and psychological distress varies, depending on workers' living situation with family members.

Workplace infection control measures and romantic activities of workers during COVID-19 pandemic: A prospective cohort study in Japan.

Objective: Due to the COVID-19 pandemic, non-married people are at high risk of loneliness. With social interactions restricted, it is important for non-married people to acquire a new romantic partner for their mental health and quality of life. We hypothesized that infection control efforts in the workplace influence people's social interactions, including romantic activities. Methods: We conducted an internet-based prospective cohort study from December 2020 (baseline) to December 2021, using self-administered questionnaires. Briefly, 27,036 workers completed the questionnaires at baseline, and when followed up after 1 year, 18,560 (68.7%) participated. A total of 6,486 non-married individuals with no romantic relationship at baseline were included in the analysis. At baseline they were asked about the implementation of infection control measures in the workplace, and at follow-up they were asked about activities they performed with a view to romantic relationships during the period from baseline to follow-up. Results: Compared to workers in workplaces with no infection control measures, the odds ratio (OR) associated with romance-related activities for those in workplaces with seven or more infection control measures was 1.90 (95% CI: 1.45-2.48, p < 0.001), and the OR associated with having a new romantic partner was 1.79 (95% CI: 1.20-2.66, p = 0.004). Discussion: Under the COVID-19 pandemic, the implementation of infection control measures in the workplace and the expressed satisfaction with those measures promoted romantic relationships among non-married, single individuals.

A Cross-Sectional Study of the Association Between Telecommuting Environments and Shoulder Pain Among Japanese Telecommuting Workers.

OBJECTIVE: The aim of this study was to investigate the association between telecommuting environments and shoulder pain in Japanese telecommuters. METHODS: We conducted an Internet-monitored, cross-sectional study and analyzed 2537 participants who mainly telecommuted at least 4 days per week. We assessed the presence of shoulder pain using a numerical rating scale and the characteristics of the telecommuting environment by asking eight questions. We used multilevel logistic regression analysis with the city of residence as a random effect. RESULTS: Inadequate desk brightness (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.09-1.78), inadequate foot space (OR, 1.27; 95% CI, 1.02-1.58), and uncomfortable temperature and humidity (OR, 1.41; 95% CI, 1.16-1.72) were associated with shoulder pain in multilevel logistic regression analysis. CONCLUSIONS: Inappropriate telecommuting environments were associated with an increase in the prevalence of shoulder pain in Japanese telecommuters.

Changes in work/sleep patterns due to the COVID-19 pandemic are associated with psychological distress among Japanese workers.

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted working life quality. This study investigated whether changes in work/sleep patterns due to the pandemic are related to poor psychological status among Japanese workers during the third wave of the COVID-19 pandemic (December 2020). We hypothesized that workers who experienced drastic changes in working hours and sleep duration would be at an increased risk of psychological distress. Methods: A cross-sectional self-administered Internet survey was conducted that included questions regarding socio-demographics, lifestyle, health, and occupational background and conditions. Multivariable logistic regression models were utilized to examine the association between psychological distress and a combination of changes in working hours and sleep duration. Results: Among 25,762 workers, decreased work hours and decreased sleep duration presented 2.59 times higher odds of psychological distress (95% confidence interval [CI] = 2.05-3.28) compared to those who had no changes in work hours combined with unchanged sleep duration (reference group). Increased work hours and decreased sleep duration were associated with 1.98 times higher odds of psychological distress (95% CI = 1.64-2.39). Conclusion: Our observations confirmed that decreased sleep duration could be a key factor for psychological distress, irrespective of working hours. Interestingly, workers with a combination of decreased work hours and sleep duration posed the highest risk of psychological distress. Decreased work hours accompanied by financial difficulties in the early stage of the pandemic may have caused decreased sleep duration, resulting in a high prevalence of psychological distress. Our study underlined the importance of sleep management in maintaining workers' mental health, moreover, the need to consider situations and conditions of other daily tasks, such as work hours, for better sleep management.

Association between preventive measures against workplace infection and preventive behavior against personal infection.

To prevent the spread of infection, it is necessary for each individual to adopt infection prevention behavior. We investigated the effect of infection control measures implemented in the workplace on personal infection prevention behavior. We conducted a self-administered questionnaire survey through the Internet from December 22 to 25, 2020, during which period coronavirus disease 2019 (COVID-19) was spreading. Among respondents aged 20 to 65 years (n=27,036), 21,915 workers were included in the analysis. The results showed that as the number of infection control measures in the workplace increased, implementation of infection prevention behavior by individuals also significantly increased. However, the relationship differed depending on the type of personal infection prevention behavior. Specifically, infection control measures against COVID-19 in the workplace may affect personal infection prevention behavior. Implementation of infection control measures in the workplace increases awareness of the importance of individual infection prevention behavior and its implementation by all individuals. These findings may be applicable not only to COVID-19 measures but also to responses to other emerging infections and seasonal influenza.

Job stress and work from home during the COVID-19 pandemic among Japanese workers: a prospective cohort study.

Objectives: The work style reforms and the coronavirus disease pandemic in Japan have prompted efforts toward teleworking, mainly work from home (WFH). This study aimed to prospectively evaluate the impact of WFH on job stress among Japanese workers. Methods: This online survey-based prospective cohort study was conducted from December 2020 (baseline) to December 2021 (1-year follow-up) using self-administered questionnaires. At baseline, 27,036 participants completed the questionnaires, whereas 18,560 (68.7%) participated in the 1-year follow-up. After excluding the 11,604 participants who left or changed workplaces within 1 year or who were physical laborers and hospitality workers, data from 6,956 participants were analyzed. We asked participants about WFH frequency at baseline and conducted a follow-up using the Brief Job Stress Questionnaire (BJSQ). Participants were divided into four groups according to WFH frequency. The odds ratios of poor states of the association of the four subscales (job demand, job control, supervisor support, and coworker support) determined by the BJSQ with WFH frequency were estimated using a multilevel logistic model. Results: In both the gender-age adjusted and multivariate models, compared to the non-WFH group, the medium and low WFH groups were less likely to have poor job control, whereas the high WFH group were likely to have similar levels as the non-WFH group. In both models, compared to non-WFH participants, the high WFH group were more likely to have poor supervisor and coworker support. Conclusions: High-frequency WFH requires further attention, because it may increase job stress by exacerbating deficits of social support in the workplace. Medium- and low-frequency WFH workers were more likely to have satisfactory job control; therefore, limiting WFH to three or fewer days per week may lead to better job stress management.

Relationship between Psychological Distress and Poverty among Japanese Workers during the COVID-19 Pandemic: A Prospective Cohort Study.

OBJECTIVE: This study aimed to examine the relationship between psychological distress and poverty among Japanese workers during the COVID-19 pandemic. METHOD: An internet based prospective cohort study was conducted. A total of 11,081 individuals who were not experiencing poverty at baseline in December 2020 were included. The exposure variable was psychological distress evaluated using the Kessler 6 scale at baseline. The outcome variable was whether participants were experiencing poverty at the one-year follow-up, as defined by household financial distress. RESULT: Compared to individuals without psychological distress, the adjusted odds ratios of household financial distress among those with mild and severe psychological distress were 2.88 (95% CI: 2.47-3.33, p < 0.001) and 3.19 (95% CI: 2.52-4.04, p < 0.001), respectively. CONCLUSION: Workers' psychological distress is a notable public health concern in the context of poverty.

Psychological Distress, Japanese Teleworkers, and Supervisor Support During COVID-19.

OBJECTIVE: During the COVID-19 pandemic, teleworking became the new workplace norm, creating a new challenge for workplace communication. This study investigated the association between source-specific workplace social support and psychological distress among Japanese teleworkers and nonteleworkers. METHODS: A total of 15,045 workers were extracted from a cross-sectional web-based survey that assessed psychological distress, workplace social support from supervisors and coworkers. After grouping participants into four groups based on their positions (managers, staff members) and teleworking arrangements (teleworking, nonteleworking), multiple logistic regression analyses were performed separately. RESULTS: Teleworkers with less supervisor support demonstrated the highest risk of psychological distress (adjusted odds ratio = 2.55, P = 0.024). CONCLUSIONS: Insufficient supervisor support for teleworking staff members may be a key occupational risk factor for psychological distress in the postpandemic future.

Effect of COVID-19 infection related experiences on social behaviors when a state of emergency is declared: a cohort study.

BACKGROUND: Restricting the movement of the public to gathering places and limiting close physical contact are effective measures against COVID-19 infection. In Japan, states of emergency have been declared in specific prefectures to reduce public movement and control COVID-19 transmission. We investigated how COVID-19 infection related experiences including people with a history of infection, people with a history of close contact, and people whose acquaintances have been infected, affected self-restraint from social behaviors during the second state of emergency in Japan. METHODS: A prospective cohort study was conducted among workers aged 20-65 years using data from an internet survey. The baseline survey was conducted on December 22-25, 2020, and a follow-up survey was on February 18-19, 2021. There were 19,051 participants who completed both surveys and were included in the final analysis. We identified eight social behaviors: (1) eating out (4 people or fewer); (2) eating out (5 people or more); (3) gathering with friends and colleagues; (4) day trip; (5) overnight trip (excluding visiting home); (6) visiting home; (7) shopping for daily necessities; and (8) shopping for other than daily necessities. We set self-restraint regarding each social behavior after the second state of emergency was declared in January 2021 as the dependent variable, and COVID-19 infection related experiences as independent variables. Odds ratios were estimated using multilevel logistic regression analyses nested in the prefecture of residence. RESULTS: Significant differences by COVID-19 infection related experiences were identified: compared to people without COVID-19 related experiences, people with a history of COVID-19 were less likely self-restraint from most social behaviors. People whose acquaintance had been diagnosed with COVID-19 were significantly more likely to refrain from most social behaviors. There was no significant difference in any social behaviors for people with a history of close contact only. CONCLUSION: To maximize the effect of a state of emergency, health authorities should disseminate information for each person in the target population, taking into account potential differences related to the infection related experiences.

Association of alcohol consumption and frequency with loneliness: A cross-sectional study among Japanese workers during the COVID-19 pandemic.

Background: There are increasing concerns that prevention measures against coronavirus disease 2019 (COVID-19) such as social distancing and telework are leading to loneliness and poor lifestyle habits like increased alcohol consumption. The purpose of this study was to assess whether loneliness reported among workers during the COVID-19 pandemic is associated with changes in alcohol consumption. Methods: The study comprised a cross-sectional, online survey of 27,036 workers between December 22 and 26, 2020. A questionnaire was used to assess loneliness, usual alcohol consumption and whether that consumption had changed. Odds ratios (ORs) were estimated by logistic regression analysis. Results: A total of 2831 (10.5%) workers indicated they had increased alcohol consumption during the pandemic. Increased alcohol consumption was significantly associated with loneliness (OR = 1.94, 95%CI 1.70-2.21). This association held true for those who indicated they drank two or more days per week (OR = 1.98 95%CI 1.71-2.30) and those who drank less than one day per week (OR = 1.51 95%CI 0.71-3.25). In contrast, there was no association between increased alcohol consumption and loneliness among those who indicated they hardly ever drank (OR = 1.22 95%CI 0.55-2.72). Conclusions: Among those drinking more than once a week, increased alcohol consumption is associated with loneliness.

Occupational Factors Associated with Telemedicine Use in the Japanese Working-Age Population: A Web-Based Study Conducted during the COVID-19 Pandemic.

Telemedicine has significant potential for helping workers access medical treatment. To improve workers' access to telemedicine, it is important to analyze current utilization rates and influencing factors. Therefore, the purpose of this study is to evaluate the associations between occupational factors and telemedicine use. A 1-year follow-up study of 4,882 full-time workers receiving regular treatment in Japan was conducted from December 2020 to December 2021. Occupational factors associated with the use of telemedicine were evaluated by multivariate logistic regression analysis. In total, 191 participants had experience of using telemedicine (3.9%). The most common comorbidity was hypertension (37.0%), followed by back pain and arthritis (19.8%) and depression and psychiatric disorders (14.5%). Managers and executives [adjusted odds ratio (aOR) = 1.92, 95% confidence interval (CI): 1.68-3.43, P < = 0.026], finance industry workers (aOR = 2.61, 95% CI: 1.24-5.49, P = 0.011), and individuals with experience of teleworking (aOR = 2.08, 95% CI: 1.52-2.85, P < 0.001) were more likely to use telemedicine. Telemedicine usage was least common among workers aged 50-59 years (aOR = 0.35, 95% CI: 0.22-0.57, P < 0.001) and those with long working hours (≥ 9.0 hours/day) (aOR = 0.59, 95% CI: 0.38-0.93, P < 0.022). The utilization rate of telemedicine in Japan is still low. This study identified occupational factors related to the use of telemedicine, such as worker's age, employee status, working hours, and experience of teleworking. Our findings suggest that flexible work arrangements could promote widespread use of telemedicine.

Association between Perceived Organizational Support for Infection Prevention and Work Engagement during the COVID-19 Pandemic among Japanese Workers: A Prospective Cohort Study.

Although the correlation between perceived organizational support (POS) and work engagement has been investigated in several studies, the relationship between health-focused POS and work engagement has not been clarified. We prospectively evaluated the influence of workers' POS for infection prevention (POS-IP) on employees' work engagement. This prospective cohort study was conducted from December 2020 (baseline) to December 2021 (1-year follow-up) using a self-administered internet questionnaire. At follow-up, there were 18,560 respondents, and after excluding 6677 respondents who had changed jobs or retired since baseline or who were self-employed; thus, 11,883 participants were included in the analysis. We asked participants a single question on POS-IP and the three-item Utrecht Work Engagement Scale (UWES-3), and then analyzed the relationship between POS-IP at baseline and UWES-3 at follow-up using multilevel regression analysis. Work engagement at follow-up was significantly higher in the groups with "low", "high", and "very high" POS-IP at baseline as compared with the "very low" group (all, p < 0.001). A dose-response relationship was also observed between the POS-IP categories at baseline and work engagement at follow-up (p for trend < 0.001). During the COVID-19 pandemic, POS-IP can increase work engagement after 1 year.

Workplace Infection Control Measures and Perceived Organizational Support During the COVID-19 Pandemic in Japan: A Prospective Cohort Study.

OBJECTIVE: We investigated whether workplace infection control measures during the COVID-19 pandemic could increase perceived organizational support (POS). METHODS: This prospective cohort study was conducted in Japan from December 2020 to December 2021 using a questionnaire survey. There were 18,560 respondents at follow-up; we investigated 4971 who rated low POS at baseline. The participants were asked a single question about POS and nine about workplace infection control measures. We determined the odds ratios (ORs) of high POS at follow-up using multilevel logistic regression analysis. RESULTS: The groups of 5 to 6 (OR = 1.29, 95% confidence interval = 1.05-1.57, P = 0.014) and 7 to 9 workplace infection control measures (OR = 1.54, 95% confidence interval, 1.28-1.85, P < 0.001) had significantly higher ORs than the group with 0 to 2 measures. CONCLUSIONS: Health support for employees through workplace infection control measures can increase POS.

Workplace vaccination opportunity against COVID-19 contributed to high perceived organizational support of employees in Japan: A prospective cohort study.

OBJECTIVES: Perceived organizational support is a broad perception by employees about the extent to which their employer values their contributions and cares about their well-being. We examined the relationship between workplace vaccination opportunities for COVID-19 provided by companies and increases and decreases in perceived organizational support, using a prospective cohort study. METHODS: This study was conducted between December 2020 and December 2021 using a self-administered questionnaire survey in Japan. In total, 18 560 people responded to the follow-up, and were included in this study. The odds ratios (ORs) for the association between company-arranged vaccination opportunities and high perceived organizational support at the follow-up for participants (a) with low perceived organizational support at the baseline (n = 4971), and (b) with high perceived organizational support at the baseline (n = 6912) were separately estimated using a multilevel logistic model. RESULTS: The OR of high perceived organizational support at the follow-up after low baseline levels was significantly higher in participants given a vaccination opportunity than those not given this opportunity (OR 1.49; 95% confidence interval [CI] 1.32-1.67; p < .001). The OR of high perceived organizational support at the follow-up after high baseline levels was also significantly highly in participants given a vaccination opportunity than not (OR 1.38; 95% CI 1.23-1.54; p < .001). These significant differences remained after adjusting for workplace infection control measures. CONCLUSIONS: Employee health support provided through a workplace vaccination program can contribute to high perceived organizational support.

Effect of working place infection control practices on workers' psychological distress: A large-scale cohort study during the COVID-19 pandemic in Japan

Background The COVID-19 pandemic has dramatically transformed the work environment and practices worldwide. Long-term infection control practices may increase the psychological distress of workers, and, conversely, inadequate infection control practices in the working place may increase the fear of infection. This study aimed to determine the relationship between infection control practices in the working place and employee mental state during the COVID-19 pandemic in Japan. Methods This study was conducted in December 2020 and February 2021. The participants had undergone a preliminary survey, which revealed that they were in a good mental state. Their psychological distress was investigated via a second survey, and the factors associated with distress were studied using a logistic model. Results The results of the second survey indicated that 15.3% of participants demonstrated psychological distress. This was associated with leave-of-absence instructions, instructions for shortening business hours, and requests to avoid the working place in case of any symptoms. Conclusion The study found that while some infection control practices reduce workers' distress, others worsen it. Employers need to consider infection control practices as well as the worsening mental state of employees following a decrease in income caused by such measures. Follow-up studies may be necessary to clarify the long-term effects on workers' mental states.

Spread of infection and treatment interruption among Japanese workers during the COVID-19 pandemic: A cross-sectional study.

Background: The COVID-19 pandemic has resulted in treatment interruption for chronic diseases. The scale of COVID-19 in Japan has varied greatly in terms of the scale of infection and the speed of spread depending on the region. This study aimed to examine the relationship between local infection level and treatment interruption among Japanese workers. Methods: Cross-sectional internet survey was conducted from December 22 to 26, 2020. Of 33,302 participants, 9,510 (5,392 males and 4,118 females) who responded that they required regular treatment were included in the analysis. The infection level in each participant's prefecture of residence was assessed based on the incidence rate (per 1,000 population) and the number of people infected. Age-sex and multivariate adjusted odds ratios (ORs) of regional infection levels associated with treatment interruption were estimated by multilevel logistic models, nested by prefecture of residence. The multivariate model was adjusted for sex, age, marital status, equivalent household income, educational level, occupation, self-rated health status and anxiety. Results: The ORs of treatment interruption for the lowest and highest levels of infection in the region were 1.32 [95 % confidence interval (CI) were 1.09-1.59] for the overall morbidity rate (per 1,000) and 1.34 (95 % CI 1.10-1.63) for the overall number of people infected. Higher local infection levels were linked to a greater number of workers experiencing treatment interruption. Conclusions: Higher local infection levels were linked to more workers experiencing treatment interruption. Our results suggest that apart from individual characteristics such as socioeconomic and health status, treatment interruption during the pandemic is also subject to contextual effects related to regional infection levels. Preventing community spread of COVID-19 may thus protect individuals from indirect effects of the pandemic, such as treatment interruption.