SARS-CoV-2 infection risk by non-healthcare occupations: a systematic review and meta-analysis

Abstract

Background: During the COVID-19 pandemic, several industries were deemed essential. However, information on infection risk in occupational settings outside of healthcare workers and medical staff (HCWs) remain scarce. Thus, a systematic review with meta-analysis was conducted to compile the risk of infection to SARS-CoV-2 in non-healthcare workers (non-HCWs). Methods: We screened three databases (EMBASE, PubMed, medRχiv) for studies on SARS-CoV-2 infection risk in working population. Several stages of severity (infection, hospitalisation, admission to intensive care unit (ICU), mortality) were eligible. Occupational specifications were harmonised according to the German classification of professions (KldB). All reported risk estimators were considered. Studies were analysed for their risk of bias. Results of random-effects meta-analyses were assessed for their evidence according to GRADE. Subgroup analyses were run for ‘outcome’, ‘comparison group’, and ‘risk of bias’. Results: Of 9,081 publications identified, 25 were recognised as eligible, mainly describing the first year of the pandemic. For 20 occupations, we were able to carry out meta-analyses on KldB-4-level by integrating all stages of severity. Nine occupations were identified with a statistically significantly increased risk of infection for SARS-CoV-2, four of which had a relative risk (RR) of > 2: Occupations in meat processing (RR = 3.58 [95%-CI 1.46; 8.77]), occupations in building cleaning services (RR = 2.55 [95%-CI 1.51; 4.31]), occupations in cargo handling (RR = 2.52 [95%-CI 2.27; 2.79]) and cooks (RR = 2.53 [95%-CI 1.75; 3.67]). The certainty of evidence of eight results was found moderate or high. Conclusions: The first systematic review and meta-analysis of occupational SARS-CoV-2 infection risk in occupations other than HCWs revealed a considerably elevated risk in individual related services as well as in commercial services. Trial registration: PROSPERO CRD42021297572.