Excess mortality among essential workers in England and Wales during the COVID-19 pandemic: an updated analysis.

BACKGROUND: Excess mortality from all causes combined during the COVID-19 pandemic in England and Wales in 2020 was predominantly higher for essential workers. In 2021, the vaccination programme had begun, new SARS-CoV-2 variants were identified and different policy approaches were used. We have updated our previous analyses of excess mortality in England and Wales to include trends in excess mortality by occupation for 2021. METHODS: We estimated excess mortality for working age adults living in England and Wales by occupational group for each month in 2021 and for the year as a whole. RESULTS: During 2021, excess mortality remained higher for most groups of essential workers than for non-essential workers. It peaked in January 2021 when all-cause mortality was 44.6% higher than expected for all occupational groups combined. Excess mortality was highest for adults working in social care (86.9% higher than expected). CONCLUSION: Previously, we reported excess mortality in 2020, with this paper providing an update to include 2021 data. Excess mortality was predominantly higher for essential workers during 2021. However, unlike the first year of the pandemic, when healthcare workers experienced the highest mortality, the highest excess mortality during 2021 was experienced by social care workers.

Occupational differences in SARS-CoV-2 infection: analysis of the UK ONS COVID-19 infection survey.

BACKGROUND: Concern remains about how occupational SARS-CoV-2 risk has evolved during the COVID-19 pandemic. We aimed to ascertain occupations with the greatest risk of SARS-CoV-2 infection and explore how relative differences varied over the pandemic. METHODS: Analysis of cohort data from the UK Office of National Statistics COVID-19 Infection Survey from April 2020 to November 2021. This survey is designed to be representative of the UK population and uses regular PCR testing. Cox and multilevel logistic regression were used to compare SARS-CoV-2 infection between occupational/sector groups, overall and by four time periods with interactions, adjusted for age, sex, ethnicity, deprivation, region, household size, urban/rural neighbourhood and current health conditions. RESULTS: Based on 3 910 311 observations (visits) from 312 304 working age adults, elevated risks of infection can be seen overall for social care (HR 1.14; 95% CI 1.04 to 1.24), education (HR 1.31; 95% CI 1.23 to 1.39), bus and coach drivers (1.43; 95% CI 1.03 to 1.97) and police and protective services (HR 1.45; 95% CI 1.29 to 1.62) when compared with non-essential workers. By time period, relative differences were more pronounced early in the pandemic. For healthcare elevated odds in the early waves switched to a reduction in the later stages. Education saw raises after the initial lockdown and this has persisted. Adjustment for covariates made very little difference to effect estimates. CONCLUSIONS: Elevated risks among healthcare workers have diminished over time but education workers have had persistently higher risks. Long-term mitigation measures in certain workplaces may be warranted.

A Systematic Review of the Routes and Forms of Exposure to Engineered Nanomaterials.

Background: Establishing the routes of exposure is a fundamental component of the risk assessment process for every dangerous substance. The present study systematically reviews the available literature to assess the relevance of the different routes and forms of exposure that are of concern for the protection of workers during the manufacture, handling, or end-use of engineered nanomaterials (ENMs). Methods: A systematic review of the peer-reviewed literature published between 2000 and 2015 was completed. Only studies including measurements of inhalation or dermal exposure were selected and used to identify the exposure situations for which the measurements were collected. The identified exposure situations were grouped based on the type of ENM (i.e. carbon nanotubes and fibres, silicon-based, titanium dioxide, other metal oxides, pure elemental metals, and other ENMs) and activity involved. The grouped exposure situations were assessed to provide a conclusion regarding the likelihood, form, and route of exposure. Assessment of the likelihood of exposure was based on well-defined criteria using a previously established decision logic for inhalation exposure and the outputs from measurements and/or conceptual models for dermal/ingestion exposure. For each combination of nano-activity and type of ENM, the aggregated likelihood across all relevant individual assessments was used to draw conclusions about the relevance of both the inhalation and dermal/ingestion routes. Based on the quality of the data, the strength of the evidence was also evaluated. Results: One hundred and seven studies were identified during the review process, reporting 424 individual exposure assessments. Measurement data were limited for dermal/ingestion exposure and for inhalation exposure for downstream use and end-of-life. However, the data provided high-quality evidence that in occupational settings all three routes can be of relevance for exposure to ENMs. In general, whenever inhalation exposure occurs then dermal and inadvertent ingestion exposure may occur due to surface deposition and transfer due to the ENMs release. However, for some forms of exposure (e.g. suspension/liquids), dermal exposure can occur even when inhalation exposure is unlikely. An increased likelihood of exposure was observed for manual activities such as cleaning and maintenance, collection/harvesting, spraying, and finishing as well as those involving feeding into a process and handling of powders outside enclosures. The likelihood of exposure was affected by the presence of risk management measures and the scale of the production involved. Conclusion: This literature review provides evidence that for ENMs, as found for other materials, the likelihood of the exposure depends largely on the physical form of the substance as well as the applied process and operational conditions. These results can be used to provide first indications of the likelihood of exposure and guidance for exposure controls in workplaces. However, there is a clear lack of high-quality exposure data, in particular for downstream use and end-of-life scenarios and in low- and medium-income countries.

Interactions between occupational exposure to extremely low frequency magnetic fields and chemicals for brain tumour risk in the INTEROCC study.

OBJECTIVES: In absence of clear evidence regarding possible effects of occupational chemical exposures on brain tumour aetiology, it is worthwhile to explore the hypothesis that such exposures might act on brain tumour risk in interaction with occupational exposure to extremely low frequency magnetic fields (ELF). METHODS: INTEROCC is a seven-country (Australia, Canada, France, Germany, Israel, New Zealand and UK), population-based, case-control study, based on the larger INTERPHONE study. Incident cases of primary glioma and meningioma were ascertained from 2000 to 2004. Job titles were coded into standard international occupational classifications and estimates of ELF and chemical exposures were assigned based on job-exposure matrices. Dichotomous indicators of cumulative ELF (≥50th vs <50th percentile, 1-4 year exposure time window) and chemical exposures (ever vs never, 5-year lag) were created. Interaction was assessed on both the additive and multiplicative scales. RESULTS: A total of 1939 glioma cases, 1822 meningioma cases and 5404 controls were included in the analysis, using conditional logistic regression. There was no clear evidence for interactions between ELF and any of the chemical exposures assessed for either glioma or meningioma risk. For glioma, subjects in the low ELF/metal exposed group had a lower risk than would be predicted from marginal effects. Results were similar according to different exposure time windows, to cut-points of exposure or in exposed-only analyses. CONCLUSIONS: There was no clear evidence for interactions between occupational ELF and chemical exposures in relation to glioma or meningioma risk observed. Further research with more refined estimates of occupational exposures is recommended.