Disparities in COVID-19 fatalities among working Californians

BACKGROUND: Information on U.S. COVID-19 mortality rates by occupation is limited. We aimed to characterize 2020 COVID-19 fatalities among working Californians to inform preventive strategies. METHODS: We identified laboratory-confirmed COVID-19 fatalities with dates of death in 2020 by matching death certificates to the state’s COVID-19 case registry. Working status for decedents aged 18–64 years was determined from state employment records, death certificates, and case registry data and classified as “confirmed working,” “likely working,” or “not working.” We calculated age-adjusted overall and occupation-specific COVID-19 mortality rates using 2019 American Community Survey denominators. RESULTS: COVID-19 accounted for 8,050 (9.9%) of 81,468 fatalities among Californians 18–64 years old. Of these decedents, 2,486 (30.9%) were matched to state employment records and classified as “confirmed working.” The remainder were classified as “likely working” (n = 4,121 [51.2%]) or “not working” (n = 1,443 [17.9%]) using death certificate and case registry data. Confirmed and likely working COVID-19 decedents were predominantly male (76.3%), Latino (68.7%), and foreign-born (59.6%), with high school or less education (67.9%); 7.8% were Black. The overall age-adjusted COVID-19 mortality rate was 30.0 per 100,000 workers (95% confidence interval [CI], 29.3–30.8). Workers in nine occupational groups had age-adjusted mortality rates higher than this overall rate, including those in farming (78.0; 95% CI, 68.7–88.2); material moving (77.8; 95% CI, 70.2–85.9); construction (62.4; 95% CI, 57.7–67.4); production (60.2; 95% CI, 55.7–65.0); and transportation (57.2; 95% CI, 52.2–62.5) occupations. While occupational differences in mortality were evident across demographic groups, mortality rates were three-fold higher for male compared with female workers and three- to seven-fold higher for Latino and Black workers compared with Asian and White workers. CONCLUSION: Californians in manual labor and in-person service occupations experienced disproportionate COVID-19 mortality, with the highest rates observed among male, Latino, and Black workers; these occupational group should be prioritized for prevention.