背景:COVID-19大流行期间的早期研究表明,由于多种因素增加暴露,牙科职业是暴露于SARs-CoV-2的最高风险之一,包括靠近未掩盖的患者和气溶胶生成程序的性能。然而,到目前为止,很少有研究调查COVID-19在美国牙科职业中的死亡,并比较了医疗保健行业的COVID-19死亡人数。
方法:我们分析了国家卫生统计中心国家生命统计系统收集的2020年死亡率数据。多变量逻辑回归用于生成COVID-19的比值比(ORs)和95%置信区间,作为与工作年龄死者(≤65岁)的职业相关的死亡根本原因,在调整了年龄之后,性别,种族/民族,教育,以及与严重COVID-19相关的医疗状况。
结果:牙科职业与所有其他职业的合并相比,COVID-19死亡的风险没有明显升高。在频繁的医疗保健职业中,直接的患者或客户互动,LPN和LVN,与牙医相比,言语和语言病理学家对COVID-19死亡的校正OR显著升高,牙科保健员,或牙科助理。同样,护士对COVID-19死亡率的OR显著高于牙医或牙科卫生师,与牙科助理相比,其重要性接近。相反,与牙科职业相比,按摩治疗师和其他健康诊断和治疗从业者对COVID-19死亡的校正OR显著较低。
结论:我们的研究强调了医疗保健行业中与工作相关的SARs-CoV-2传播和随后的COVID-19死亡的潜在差异,在COVID-19疫苗上市之前,进一步加深了对2020年医疗保健行业COVID-19死亡的有限理解。我们的结果表明,牙科职业不是最高的,也不是最低风险,2020年COVID-19死亡的医疗保健职业,尽管他们已知直接接触的风险。
BACKGROUND: Early studies during the COVID-19 pandemic suggested dental occupations were among the highest risk for exposure to SARs-CoV-2 because of multiple factors increasing exposure, including close proximity to unmasked patients and performance of aerosol-generating procedures. However, to date, few studies have investigated COVID-19 deaths in United States dental occupations, and compared COVID-19 deaths among healthcare occupations.
METHODS: We analyzed 2020 mortality data collected by the National Center for Health Statistics\' National Vital Statistics System. Multivariable logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals for COVID-19 as the underlying cause of death in relation to occupation in working-age decedents (≤65 years), after adjusting for age, sex, race/ethnicity, education, and medical conditions associated with severe COVID-19.
RESULTS: Dental occupations did not have significantly higher risk for COVID-19 death when compared to all other occupations combined. Among healthcare occupations with frequent, direct patient- or client interactions, LPNs and LVNs, and speech and language pathologists had significantly elevated adjusted ORs for COVID-19 death when compared to dentists, dental hygienists, or dental assistants. Similarly, nurse practitioners had significantly higher ORs for COVID-19 mortality than dentists or dental hygienists, and approached significance when compared to dental assistants. Conversely, massage therapists and other health diagnosing and treating practitioners had significantly lower adjusted ORs for COVID-19 death compared with dental occupations.
CONCLUSIONS: Our study highlights potential differences in work-related transmission of SARs-CoV-2 and subsequent COVID-19 deaths in healthcare occupations, and furthers a previously limited understanding of COVID-19 deaths in healthcare occupations in 2020, before COVID-19 vaccine availability. Our results indicate that dental occupations were not among the highest, nor lowest risk, healthcare occupations for COVID-19 deaths in 2020, despite their known risks of direct exposure.