A new study has found that the disproportionate rate of coronavirus disease 2019 (COVID-19) incidence among immigrant groups in Norway may not be a result of occupational risks.
Although the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread around the globe, it affects populations differently. Immigrants seem to have higher infection rates than natives. In Norway and Sweden, immigrants from Somalia, Pakistan, and Iraq have high infection rates. In the United States (US) and the United Kingdom (UK), ethnic minorities and people in the disadvantaged socioeconomic group are at higher risk of COVID-19.
However, in Norway, the role of socioeconomic position in immigrants and high risk of COVID-19 has not been studied. Occupation could be an important factor in COVID-19’s spread. A recent study showed that bartenders, waiters, taxi drivers, and travel stewards were at higher risk during the second wave of the pandemic. In the UK, the occupational risk of COVID-19 was higher among persons of color (POC), irrespective of their occupation, with POC essential workers being at the highest risk.
Understanding if occupations play a role in high COVID-19 burden among immigrants could help define actions targeting occupations at risk to reduce the number of infections in immigrants.
Using data from employees registered in Norway, researchers from the Norwegian Institute of Public Health investigated whether immigrants in different occupations were more at risk of COVID-19 compared to native Norwegians in the same occupations. They published their results in the medRxiv* preprint server.
Correlating occupations and COVID-19 risk
The researchers used a new emergency preparedness register established in April 2020, covering all Norwegian residents. All confirmed COVID-19 cases are reported to the Norwegian Surveillance System for Communicable Diseases (MSIS). The emergency preparedness register used data from MSIS, the population register, the patient register and employer and employee register, to link the data at the individual level using a unique personal identification number provided to each resident upon birth or immigration.
Their study population included everyone born in Norway as well as immigrants from Somalia, Pakistan, Iraq, Afghanistan, and Turkey between 20 and 70 years old.
Grouping by occupation, the authors found that the highest cases in Somalis were among taxi drivers, nurses, and healthcare workers. Among the Pakistanis, bus drivers and childcare workers had the highest positive cases. Healthcare workers among the Iraqis, bus drivers and cleaners among Afghanis, and shop salespersons among Turks had the highest levels of infections.
When comparing Norwegian-born people and immigrants among the different occupations, the team found the immigrants had higher odds of contracting the virus among natives in the same occupation.
Among the immigrant occupations, healthcare workers were at higher risk than others among the immigrants from Somalia, Afghanistan, and Iraq. Waiters from Pakistan were at more risk than others from that country.
Risk similar to immigrants in general
The results show there is a modest effect of occupation on COVID-19 infection rates among immigrants in Norway. The immigrants from the countries studied had a higher chance of COVID-19 for most occupations than native Norwegians. However, this difference in risk within occupation groups is similar to the difference in risk between immigrants and non-immigrants in general.
Immigrants usually live in large, crowded households, and infections contracted at work may easily pass on to household members. This effect may make it more difficult to understand the occupational risk of infection. The authors plan to continue this study to extended families whenever data is available.
A high chance of infection was seen in healthcare workers and Norwegian-born nurses. This may be because of frequent testing of healthcare workers early in the pandemic. Once the testing was made open to anyone with symptoms, the risk of infection was higher in healthcare workers, both immigrant and non-immigrant, but the risk for Norwegian-born nurses did not have a higher probability of infection compared to other Norwegian-born people.
Although the authors found associations between occupations and COVID-19 risk among immigrants, the study did not adjust for income or education and living conditions, which could also be factors for risk of infection. There could also be differences within occupational groups in working conditions and tasks. In addition, distance to other people at work and the possibility to work from home may also be important.
Thus, the study results indicate that immigrants from Somalia, Pakistan, Iraq, Afghanistan, and Turkey in various occupations that involve close contact with others were not at higher risk of COVID-19 than others of that same country, except for healthcare workers. Occupations thus, do not seem to have an important role in the disproportionate infections observed in immigrants. There likely are a complex set of factors involved.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.