Underlying Health Conditions Among Essential Workers, 2017–2018 (MMWR)

Summary

• Already known: some underlying medical conditions raise the risk of severe COVID-19, and many essential workers face high exposure to SARS-CoV-2 through close contact with patients, the public or coworkers.
• This report: home health aides, other health care support workers, and nursing home, trucking and transit workers had high rates of such conditions.
• Implication: essential workers — especially those with underlying conditions — need exposure controls and health care access to prevent and treat those conditions.

The study

CDC's National Institute for Occupational Safety and Health analyzed 2017 and 2018 data from the Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey of adults, in the 31 states that asked about industry and occupation. The sample: 213,518 employed respondents.

• Six occupations: health practitioners; health technicians and technologists; other health care support; home health aides; protective services (police, firefighters, correctional officers); teachers (preschool to grade 12).
• Seven industries: ambulatory health care; hospitals; nursing homes; essential retail (groceries, pharmacies, gas stations); food manufacturing; transit (buses, taxis, postal service, couriers); trucking.
• Conditions: asthma, cancer, coronary heart disease, chronic kidney disease, COPD, diabetes, hypertension, obesity (BMI ≥30) and severe obesity (BMI ≥40), and stroke — all self-reported.
• Comparison: adjusted prevalence ratios (aPRs) compared each group with all other workers, accounting for age, sex and race/ethnicity.

Who the workers were

• At least 15% of health practitioners, home health aides, and ambulatory care, transit and trucking workers were 60 or older.
• Men made up 85.2% of protective service workers and 89.2% of trucking workers.
• At least 25% of home health aides and nursing home and transit workers were non-Hispanic Black.
• Hispanic workers were most common among home health aides (20%) and in food manufacturing (36%).

Findings

Obesity and hypertension were the most common conditions in every group.

Bold: prevalence significantly higher than in other workers after adjustment. Hypertension from 2017 data only.

• Home health aides had the highest prevalence of every condition except severe obesity, and significantly elevated aPRs for five: chronic kidney disease, COPD, diabetes, obesity and severe obesity.
• Nursing home workers had elevated aPRs for six: coronary heart disease, COPD, diabetes, hypertension, obesity and severe obesity.
• Other health care support workers: diabetes, obesity and severe obesity.
• Outside health care: transit (current asthma and diabetes) and trucking (COPD, obesity, severe obesity).
• Health practitioners had aPRs significantly below 1.0 for many conditions — though some still face heavy exposure through procedures and close patient contact.

Why it matters

Home health aides and nursing home workers combine high exposure, high rates of underlying conditions, and large shares of Black, Hispanic and older workers — groups at higher risk of severe COVID-19. Long-standing inequities add to the risk: jobs that can't be done from home or at a distance, low wages, no paid sick leave, reliance on shared transportation, crowded housing, limited health care, and multiple jobs — several of which also make chronic conditions harder to manage.

The Americans with Disabilities Act covers discrimination against workers with disabilities, including those from chronic conditions. Beyond that, hazard controls and health care access can reduce exposure, prevent and treat underlying conditions, and give at-risk workers access to new prevention and treatment, so they can keep doing essential work safely.

Limitations

The data are not nationally representative; some relevant conditions weren't asked about; BRFSS doesn't measure severity or separate type 1 and type 2 diabetes; some conditions' links to severe COVID-19 were still unclear; everything is self-reported; BMI was missing for some respondents; there was no information on workplace protective measures; and not every essential group could be studied.

Sources

Based on "Prevalence of Underlying Medical Conditions Among Selected Essential Critical Infrastructure Workers — Behavioral Risk Factor Surveillance System, 31 States, 2017–2018," by Sharon R. Silver, Jia Li, Winifred L. Boal, Taylor L. Shockey and Matthew R. Groenewold, National Institute for Occupational Safety and Health, Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, citing CDC, the Cybersecurity and Infrastructure Security Agency, and others; a work of the United States government in the public domain.