Occupation and COVID-19 mortality in England: a national linked data study of 14.3 million adults.

OBJECTIVES: To estimate occupational differences in COVID-19 mortality and test whether these are confounded by factors such as regional differences, ethnicity and education or due to non-workplace factors, such as deprivation or prepandemic health. METHODS: Using a cohort study of over 14 million people aged 40-64 years living in England, we analysed occupational differences in death involving COVID-19, assessed between 24 January 2020 and 28 December 2020.We estimated age-standardised mortality rates (ASMRs) per 100 000 person-years at risk stratified by sex and occupation. We estimated the effect of occupation on COVID-19 mortality using Cox proportional hazard models adjusted for confounding factors. We further adjusted for non-workplace factors and interpreted the residual effects of occupation as being due to workplace exposures to SARS-CoV-2. RESULTS: In men, the ASMRs were highest among those working as taxi and cab drivers or chauffeurs at 119.7 deaths per 100 000 (95% CI 98.0 to 141.4), followed by other elementary occupations at 106.5 (84.5 to 132.4) and care workers and home carers at 99.2 (74.5 to 129.4). Adjusting for confounding factors strongly attenuated the HRs for many occupations, but many remained at elevated risk. Adjusting for living conditions reduced further the HRs, and many occupations were no longer at excess risk. For most occupations, confounding factors and mediators other than workplace exposure to SARS-CoV-2 explained 70%-80% of the excess age-adjusted occupational differences. CONCLUSIONS: Working conditions play a role in COVID-19 mortality, particularly in occupations involving contact with patients or the public. However, there is also a substantial contribution from non-workplace factors.

Occupational differences in COVID-19 incidence, severity, and mortality in the United Kingdom: Available data and framework for analyses.

There are important differences in the risk of SARS-CoV-2 infection and death depending on occupation. Infections in healthcare workers have received the most attention, and there are clearly increased risks for intensive care unit workers who are caring for COVID-19 patients. However, a number of other occupations may also be at an increased risk, particularly those which involve social care or contact with the public. A large number of data sets are available with the potential to assess occupational risks of COVID-19 incidence, severity, or mortality. We are reviewing these data sets as part of the Partnership for Research in Occupational, Transport, Environmental COVID Transmission (PROTECT) initiative, which is part of the National COVID-19 Core Studies. In this report, we review the data sets available (including the key variables on occupation and potential confounders) for examining occupational differences in SARS-CoV-2 infection and COVID-19 incidence, severity and mortality. We also discuss the possible types of analyses of these data sets and the definitions of (occupational) exposure and outcomes. We conclude that none of these data sets are ideal, and all have various strengths and weaknesses. For example, mortality data suffer from problems of coding of COVID-19 deaths, and the deaths (in England and Wales) that have been referred to the coroner are unavailable. On the other hand, testing data is heavily biased in some periods (particularly the first wave) because some occupations (e.g. healthcare workers) were tested more often than the general population. Random population surveys are, in principle, ideal for estimating population prevalence and incidence, but are also affected by non-response. Thus, any analysis of the risks in a particular occupation or sector (e.g. transport), will require a careful analysis and triangulation of findings across the various available data sets.

Occupation-specific suicide risk in England: 2011-2015.

BACKGROUND: Previous research has documented marked occupational differences in suicide risk, but these estimates are 10 years old and based on potentially biased risk assessments.AimsTo investigate occupation-specific suicide mortality in England, 2011-2015. METHOD: Estimation of indirectly standardised mortality rates for occupations/occupational groups based on national data. RESULTS: Among males the highest risks were seen in low-skilled occupations, particularly construction workers (standardised mortality ratio [SMR] 369, 95% CI 333-409); low-skilled workers comprised 17% (1784/10 688) of all male suicides (SMR 144, 95% CI 137-151). High risks were also seen among skilled trade occupations (SMR 135 95% CI 130-139; 29% of male suicides). There was no evidence of increased risk among some occupations previously causing concern: male healthcare professionals and farmers. Among females the highest risks were seen in artists (SMR 399, 95% CI 244-616) and bar staff (SMR 182, 95% CI 123-260); nurses also had an increased risk (SMR 123, 95% CI 104-145). People in creative occupations and the entertainment industry - artists (both genders), musicians (males) and actors (males) - were at increased risk, although the absolute numbers of deaths in these occupations were low. In males (SMR 192, 95% CI 165-221) and females (SMR 170, 95% CI 149-194), care workers were at increased risk and had a considerable number of suicide deaths. CONCLUSIONS: Specific contributors to suicide in high-risk occupations should be identified and measures - such as workplace-based interventions - put in place to mitigate this risk. The construction industry seems to be an important target for preventive interventions.Declaration of interestNone.

On the Attitudinal Consequences of Being Mindful: Links Between Mindfulness and Attitudinal Ambivalence.

A series of studies examined whether mindfulness is associated with the experience of attitudinal ambivalence. Studies 1A and 1B found that mindful individuals expressed greater comfort holding ambivalent views and reported feeling ambivalent less often. More mindful individuals also responded more positively to feelings of uncertainty (as assessed in Study 1B). Study 2 replicated these effects and demonstrated that mindful individuals had lower objective and subjective ambivalence across a range of attitude objects but did not differ in attitude valence, extremity, positivity/negativity, strength, or the need to evaluate. Study 3 showed that the link between greater ambivalence and negative affect was buffered by mindfulness, such that there was no link between the amount of ambivalence and negative affect among more mindful individuals. The results are discussed with respect to the benefits of mindfulness in relation to ambivalence and affect.

The contemporary landscape of occupational bladder cancer within the United Kingdom: a meta-analysis of risks over the last 80 years.

OBJECTIVE: To profile the contemporary risks of occupational bladder in the UK, as this is a common malignancy that arises through occupational carcinogen exposure. MATERIALS AND METHODS: A systematic review using PubMed, Medline, Embase and Web of Science was performed in March 2016. We selected reports of British workers in which bladder cancer or occupation were the main focus, with sufficient cases or with confidence intervals (CIs). We used the most recent data in populations with multiple reports. We combined odds ratios and risk ratios (RRs) to provide pooled RRs of incidence and disease-specific mortality (DSM). We tested for heterogeneity and publication bias. We extracted bladder cancer mortality from Office of National Statistics death certificates. We compered across regions and with our meta-analysis. RESULTS: We identified 25 articles reporting risks in 702 941 persons. Meta-analysis revealed significantly increased incidence for 12/37 and DSM for five of 37 occupational classes. Three classes had reduced bladder cancer risks. The greatest risk of bladder cancer incidence occurred in chemical process (RR 1.87, 95% CI 1.50-2.34), rubber (RR 1.82, 95% CI 1.4-2.38), and dye workers (RR 1.8, 95% CI 1.07-3.04). The greatest risk of DSM occurred in electrical (RR 1.49, 95% CI 1.19-1.87) and chemical process workers (RR 1.35, 95% CI 1.09-1.68). Bladder cancer mortality was higher in the North of England, probably reflecting smoking patterns and certain industries. Limitations include the lack of sufficient robust data, missing occupational tasks, and no adjustment for smoking. CONCLUSION: Occupational bladder cancer occurs in many workplaces and the risks for incidence and DSM may differ. Regional differences may reflect changes in industry and smoking patterns. Relatively little is known about bladder cancer within British industry, suggesting official data underestimate the disease.

On Feeling Torn About One's Sexuality: The Effects of Explicit-Implicit Sexual Orientation Ambivalence.

Three studies offer novel evidence addressing the consequences of explicit-implicit sexual orientation (SO) ambivalence. In Study 1, self-identified straight females completed explicit and implicit measures of SO. The results revealed that participants with greater SO ambivalence took longer responding to explicit questions about their sexual preferences, an effect moderated by the direction of ambivalence. Study 2 replicated this effect using a different paradigm. Study 3 included self-identified straight and gay female and male participants; participants completed explicit and implicit measures of SO, plus measures of self-esteem and affect regarding their SO. Among straight participants, the response time results replicated the findings of Studies 1 and 2. Among gay participants, trends suggested that SO ambivalence influenced time spent deliberating on explicit questions relevant to sexuality, but in a different way. Furthermore, the amount and direction of SO ambivalence was related to self-esteem.