Occupational differences in the prevalence and severity of long-COVID: Analysis of the ONS Coronavirus (COVID-19) Infection Survey

ObjectivesTo establish whether prevalence and severity of long-COVID symptoms vary by industry and occupation. MethodsWe utilised ONS Coronavirus Infection Survey (CIS) data (February 2021-April 2022) of working-age participants (16-65 years). Exposures were industrial sector, occupation and major Standard Occupational Classification (SOC) group. Outcomes were self-reported: (1) long-COVID symptoms; and (2) reduced function due to long-COVID. Binary (outcome 1) and ordered (outcome 2) logistic regression were used to estimate odds ratios (OR) and prevalence (marginal means) for all exposures. ResultsPublic facing industries, including teaching and education, social care, healthcare, civil service, retail and transport industries and occupations had highest odds ratios for long-COVID. By major SOC group, those in caring, leisure and other services (OR 1.44, CIs: 1.38-1.52) had substantially elevated odds than average. For almost all exposures, the pattern of odds ratios for long-COVID symptoms followed that for SARS-CoV-2 infections, except for professional occupations (OR<1 for infection; OR>1 for long-COVID). The probability of reporting long-COVID for industry ranged from 7.7% (financial services) to 11.6% (teaching and education); whereas the prevalence of reduced function by a lot ranged from 17.1% (arts, entertainment and recreation) to 22-23% (teaching and education and armed forces) and to 27% (those not working). ConclusionsThe risk and prevalence of long-COVID differs across industries and occupations. Generally, it appears that likelihood of developing long-COVID symptoms follows likelihood of SARS-CoV-2 infection, except for professional occupations. These findings highlight sectors and occupations where further research is needed to understand the occupational factors resulting in long-COVID. Key messages What is already known on this topicO_LISARS-CoV-2 infection and COVID-19 mortality in the UK varied by occupational group; yet it is not known if any occupational groups are more susceptible to long-COVID than others. C_LI What this study addsO_LIThis is the first study to examine how prevalence of long-COVID and its impacts on functional capacity differ by industrial sector and occupational groups. C_LIO_LIPrevalence of self-reported long-COVID increased with time across all exposure groups and mostly followed SARS-CoV-2 infection trends; with the exception of Professional occupations that demonstrated notable differences in the direction of odds of long-covid when compared to odds of SARS-CoV-2 infection. C_LIO_LIThose working in Teaching and education, and social care industries showed the highest likelihood of having long-COVID symptoms. The exact same pattern was observed when analysis was performed using occupational groups. When we used SOC groups the likelihood was higher in Caring, leisure and other services. C_LI How this study might affect research, practice or policyO_LIThe findings contribute to the evidence base that long-COVID differences occur across industries and occupations, provides insights for employees, employers, occupational and healthcare for the industries and occupations that may need additional support for return- to-work policies and highlights sectors and occupations where further research is needed to understand the mechanisms resulting in long-COVID and how occupational factors influence the risk of developing long-COVID or interact with long-COVID to increase the impact on activities. C_LI