The Socio-Economic and Demographic Risk Factors for SARS-CoV-2 Seropositivity Among Healthcare Workers in a UK Hospital: A Prospective Cohort Study
Tanya Lam, Anja Saso, Arturo Torres Ortiz, James Hatcher, Marc Woodman, Shruthi Chandran, Rosie Thistlethwayte, Timothy Best, Marina Johnson, Helen Wagstaffe, Annabelle Mai, Matthew Buckland, Kimberly Gilmour, David Goldblatt, Louis Grandjean, Dorcas Mirambe-Korsah, Fernanda Fenn Torrente, Jakub Wyszynski, Victoria Gander, Amy Leonard, Louise Myers, Aimee Vallot, Camille Paillas, Rose Fitzgerald, Adam Twigg, Rabia Manaf, Lois Gibbons, Hollie Powell, Richard Nar-Dorh, Ally Gray, Elias Fernandez, Aline Minja, Emily Beech, Waffa Girshab, Pei Shi Chia, Kate Webb, Malti Nakrani, Kim Gardiner, Valerija Karaluka, Karen Ryan, Dorothy Lee, Katie Groves, Hamad Khan, Shamime Nsubuga, Olivia Rosie-Wilkinson, Julia Spires, Nuria Sanchez-Clemente, Sapriya Kaur, Natasha Carroll, Jemma Efford, Gabriel Bredin, Celma Marisa Dos Santos Domingues, Sophie Foxall, Helen Ashton, Abbey Afzal, Sally Mainland, Kate Crumpler, Lucinda Dawson, Claire Smith, Maria Tabbu, Laura Chiverton, Jade Sugars, Jordan Mooney, Dorothy Chikusu, Fariba Tahami, Baratth Samy, Shomona Begum, Dhimple Patel, Philippa Wiltshire, Annie Susay, Anna Ryan, Luke Lancaster, Kavita Thind, Kate Speller, Rachel Sterling, Connor Tugulu, Sandhya Ghurburrun, Steffi Gray, Joy Mugas, Moe Kishma, Kathleen Akpokomua, Sophie White, Eleana Pieri, Sabina Shamsad, Demi Alexandrou, Odera Aguele, Katherine Miles, Anamika Jain, Subishma Gautam, Oliver Simms, Rachel Goff, Zarif Shams, Tinya Chirinda, Aaliya Nur, Tarekur Rahman,- Infectious Diseases
- Microbiology (medical)
Abstract
Background
In order to protect healthcare workers from the consequences of disease due to SARS-CoV-2 it is necessary to understand the risk factors that drive exposure and infection within hospitals. Insufficient consideration of key socio-economic variables is a limitation of existing studies that can lead to bias and residual confounding of proposed risk factors for infection.
Methods
The Co-STARS study prospectively enrolled 3679 HCWs between April 2020 and September 2020. We used multivariate logistic regression to comprehensively characterise the demographic, occupational, socio-economic and environmental risk factors for SARS-CoV-2 seropositivity.
Results
After adjusting for key confounders relative household overcrowding (OR 1.4 [CI 1.1-1.9] p = 0.006), Black, Black British, Caribbean or African ethnicity (OR 1.7 [CI 1.2-2.3] p = 0.003), increasing age (50-60 age group OR 1.8 [CI 1.3-2.4] p=<0.001), lack of access to sick pay (OR 1.8 [CI 1.3-2.4] p=<0.001) and out of hospital contact with COVID-19; staff contact (OR 1.8 [CI 1.4-2.4] p=<0.001), travel contact (OR 1.9 [CI 1.2-3.0] p = 0.008), household contact (OR 1.6 [CI 1.2-2.2] p = 0.002), other contact (OR 1.9 [CI 1.3-3.3] p = 0.029) were significantly associated with SARS-CoV-2 seropositivity. In this paediatric tertiary hospital setting, contact with known infected patients was not significantly associated with seropositivity (OR 1.2 [CI 0.6-2.1] p = 0.651).
Conclusions
Socio-economic and demographic factors outside the hospital were the main drivers of infection and exposure to SARS-CoV-2 during the first wave of the pandemic in an urban paediatric referral hospital. Overcrowding and out of hospital SARS-CoV-2 contact are less amenable to intervention. However, lack of access to sick pay among externally contracted staff is more easily rectifiable. Our findings suggest that, if addressed, providing easier access to sick pay would lead to a decrease in SARS-CoV-2 transmission and potentially that of other infectious diseases in hospital settings.