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?:abstract
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OBJECTIVE To better understand COVID-19 transmission among healthcare workers (HCW), we investigated occupational and non-occupational risk factors associated with cumulative COVID-19 incidence among a Massachusetts HCW cohort. DESIGN, SETTING, AND PARTICIPANTS The retrospective cohort study included adult HCWs in a single healthcare system from March 9 to June 3, 2020. METHODS Participants\' SARS-CoV-2 nasopharyngeal RT-PCR results and demographics were de-identified and extracted from an established occupational health, COVID-19 database at the healthcare system. HCWs from each particular job grouping had been categorized into frontline/non-frontline workers. Incidence rate ratio (IRR) and odds ratio were used to compare subgroups after excluding HCWs involved in early infection clusters before universal masking. A sensitivity analysis was performed comparing jobs with the greatest potential occupational risks with others. RESULTS 152 out of 5177 (2.94%) HCWs were diagnosed with COVID-19. Affected HCWs resided in areas with higher community attack rates (median: 1755.2 vs. 1412.4 cases per 100,000, P<0.001)(multivariate-adjusted IRR: 1.89, 95%CI: 1.03-3.44 comparing 5th to 1st quintile of community rates). After multivariate adjustment, African Americans and Hispanics had higher incidence than non-Hispanic white HCWs (IRR: 2.78, 95%CI: 1.78-4.33; and IRR: 2.41, 95%CI: 1.42-4.07, respectively). After adjusting for race and residential rates, frontline HCWs had a higher IRR (1.73, 95%CI: 1.16-2.54) compared to non-frontline HCWs overall, but not within specific job categories, nor when comparing the highest risk jobs to others. CONCLUSIONS After universal masking was instituted, the strongest risk factors associated with HCWs\' COVID-19 infection were residential community infection rate and race.
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