Racial and Ethnic Disparities Among COVID-19 Cases in Workplace Outbreaks by Industry Sector

Utah, March 6-June 5, 2020

David P. Bui, PhD; Keegan McCaffrey; Michael Friedrichs, MS; Nathan LaCross, PhD; Nathaniel M. Lewis; Kylie Sage, MS; Bree Barbeau, MPH; Dede Vilven, MPH; Carolyn Rose, MPH; Sara Braby; Sarah Willardson, MPH; Amy Carter; Christopher Smoot, MPH; Andrea Winquist, MD, PhD; Angela Dunn, MD

Disclosures

Morbidity and Mortality Weekly Report. 2020;69(33):1133-1138. 

In This Article

Abstract and Introduction

Introduction

Improved understanding of the overall distribution of workplace coronavirus disease 2019 (COVID-19) outbreaks by industry sector could help direct targeted public health action; however, this has not been described. The Utah Department of Health (UDOH) analyzed COVID-19 surveillance data to describe workplace outbreaks by industry sectors. In this report, workplaces refer to non–health care, noncongregate–living, and noneducational settings. As of June 5, 2020, UDOH reported 277 COVID-19 outbreaks, 210 (76%) of which occurred in workplaces. Approximately 12% (1,389 of 11,448) of confirmed COVID-19 cases in Utah were associated with workplace outbreaks. The 210 workplace outbreaks occurred in 15 of 20 industry sectors;* nearly one half of all workplace outbreaks occurred in three sectors: Manufacturing (43; 20%), Construction (32; 15%) and Wholesale Trade (29; 14%); 58% (806 of 1,389) of workplace outbreak-associated cases occurred in these three sectors. Although 24% of Utah's workforce in all 15 affected sectors identified as Hispanic or Latino (Hispanic) or a race other than non-Hispanic white (nonwhite),[1] 73% (970 of 1,335) of workplace outbreak-associated COVID-19 cases were in persons who identified as Hispanic or nonwhite. Systemic social inequities have resulted in the overrepresentation of Hispanic and nonwhite workers in frontline occupations where exposure to SARS-CoV-2, the virus that causes COVID-19, might be higher;[2] extra vigilance in these sectors is needed to ensure prevention and mitigation strategies are applied equitably and effectively to workers of racial and ethnic groups disproportionately affected by COVID-19. Health departments can adapt workplace guidance to each industry sector affected by COVID-19 to account for different production processes and working conditions.

Data on workplace COVID-19 outbreaks occurring during March 6–June 5, 2020, were collected from UDOH's COVID-19 case surveillance system. UDOH defined workplace outbreaks as the occurrence of two or more laboratory-confirmed COVID-19 cases occurring within the same 14-day period among coworkers in a common workplace (i.e., same facility). UDOH classifies outbreaks in congregate living facilities, educational institutions, and health care facilities as distinct outbreak types that are managed differently from general workplace outbreaks because of the special populations they serve and the setting-specific guidance they require. Thus, cases from these settings were not included in this analysis of workplace outbreaks. Case investigators collected facility addresses, business names, or both for all workplace outbreaks. Workplaces were classified according to the North American Industry Classification System (NAICS; https://www.census.gov/eos/www/naics/) into one of 20 industry sectors. NAICS codes for workplaces were obtained from Utah's Division of Corporations and Commercial Code directory of registered businesses (https://secure.utah.gov/bes/). Because of small case numbers and similarities in sector processes and settings, the sectors for Professional, Scientific, and Technical services and Information were combined into a single category, as were the Finance and Insurance, Real Estate and Rental and Leasing, and Public Administration sectors.

The distribution of workplace outbreaks and associated cases across sectors was described. Outbreak incidence (cases per 100,000 workers) was calculated using Utah sector workforce estimates reported in the 2019 Census Quarterly Workforce Indicators[1] for sector denominators; workforce estimates were not adjusted to remove workers affected by outbreaks in excluded settings (e.g., educational workers and health care workers). Descriptive statistics and chi-squared tests were used to summarize and compare demographics and outcomes (e.g., hospitalization) of persons with workplace outbreak-associated COVID-19 with persons of working age (≥15 years) with nonoutbreak–associated COVID-19 (i.e., cases not associated with an outbreak). To identify sectors in which COVID-19 racial and ethnic disparities might be unrecognized, the racial and ethnic composition of workplace outbreak-associated cases were compared with the overall racial and ethnic composition in each sector in Utah. All statistical analyses were done in R (version 3.6.1; The R Foundation); p-values <0.05 were considered statistically significant.

During March 6–June 5, 2020, UDOH reported 11,448 confirmed COVID-19 cases throughout Utah, including 1,389 (12%) associated with workplace outbreaks, 1,081 (9%) associated with outbreaks in other settings (i.e., congregate living, educational, health care), and 8,978 (78%) that were not associated with an outbreak. UDOH reported 210 workplace COVID-19 outbreaks (median cases per workplace outbreak = 4; range = 2–79) involving 15 industry sectors, most frequently in Manufacturing (43; 20%), Construction (32; 15%), and Wholesale Trade (29; 14%); these three sectors accounted for 58% (806 of 1,389) of workplace outbreak-associated cases (Table 1). The incidence among workplace outbreak-associated cases was highest in the Wholesale Trade (377 per 100,000 workers) and Manufacturing (339 per 100,000 workers) sectors.

Compared with persons aged ≥15 years with nonoutbreak–associated COVID-19 (median age = 38 years), persons with workplace outbreak-associated COVID-19 were older (median age = 41 years) (Mann-Whitney test, p = 0.01), more likely to identify as Hispanic (56.4% versus 39.8%; p <0.001), and more likely to be male (61.4% versus 50.6%; p <0.001) (Table 2). The proportion of patients hospitalized was significantly lower among persons with workplace outbreak-associated COVID-19 (6.1%) than among those with nonoutbreak–associated COVID-19 (7.6%) (p = 0.01).

Among persons with workplace outbreak-associated COVID-19, information on race and ethnicity was available for 1,335 (96%); 783 (59%) workers with workplace outbreak-associated COVID-19 identified as Hispanic, 365 (27%) as non-Hispanic white, and 187 (19%) as nonwhite. In total, 970 (73%) of persons with workplace outbreak-associated COVID-19 identified as Hispanic or nonwhite, although these ethnic/racial groups represent <24% of Utah's workforce in the 15 affected industry sectors.[1] This disparity was observed across all 15 industry sectors with the largest in Wholesale Trade (percentage point difference between percentage of Hispanic or nonwhite workers among workplace outbreak-associated COVID-19 cases and the overall workforce = 58) and Manufacturing (percentage point difference = 53) sectors (Figure).

Figure.

Percentage point difference* between the percentage of workers with workplace outbreak-associated COVID-19 who are Hispanic/Latino and nonwhite and the percentage of Hispanic/Latino and nonwhite workers within the entire industry workforce,§ by industry sector — Utah, March 6–June 5, 2020
Abbreviation: COVID-19 = coronavirus disease 2019.
*Sectors are sorted on absolute disparity between the percentage of Hispanic/Latino and nonwhite workers among workplace outbreak cases and the percentage of Hispanic/Latino and nonwhite workers in the overall industry workforce, in descending order.
Nonwhite includes the following (all non-Hispanic): black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, two or more races, or other race groups.
§Sector workforce demographics from U.S. Census Quarterly Workforce Indicators, Utah 2019 (third quarter); https://qwiexplorer.ces.census.gov/static/explore.html.
Industry sectors are based on the North American Industry Classification System (https://www.census.gov/eos/www/naics/). Because of small case numbers and similarities in sector processes and settings, Professional, Scientific, and Technical Services and Information sectors were combined into a single category, as were Finance and Insurance, Real Estate, Rental and Leasing, and Public Administration.

*The 20 industry sectors include Agriculture, Forestry, Fishing and Hunting; Mining, Quarrying, and Oil and Gas Extraction; Utilities; Construction; Manufacturing; Wholesale Trade; Retail Trade; Transportation and Warehousing; Information; Finance and Insurance; Real Estate and Rental and Leasing; Professional, Scientific, and Technical Services; Management of Companies and Enterprises; Administrative and Support and Waste Management and Remediation Services; Educational Services; Health Care and Social Assistance; Arts, Entertainment, and Recreation; Accommodation and Food Services; Other Services (except Public Administration); and Public Administration (https://www.census.gov/eos/www/naics/). No workplace outbreaks were reported in the following sectors: Agriculture, Forestry, Fishing and Hunting; Mining, Quarrying, and Oil and Gas Extraction; Utilities; Management of Companies and Enterprises; and Educational Services.
Nonwhite includes the following (all non-Hispanic): black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, two or more races, or other race groups.

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