Temporal changes in occupational risks of COVID-19 hospitalisation in Germany, 2020-2021: a case-cohort study

During the COVID-19 pandemic, certain occupational groups faced elevated infection risks. This study investigated changes in occupational risks of COVID-19 hospitalisation between 2020 and 2021.

Using a case-cohort design, we analysed data from Germany's Allgemeine Ortskrankenkasse statutory health insurance, including 28 925 COVID-19 hospitalisation cases and 498 484 non-cases in 2021. HRs with administrative workers as reference were calculated using weighted and stratified Cox regression models, adjusting for age, sex, comorbidities and socioeconomic status. The ratio of relative risk (RRR) assessed the differences between years.

Healthcare workers showed the greatest reduction in relative risk (HR₂₀₂₀=2.74, 95% CI 2.46 to 3.05; HR₂₀₂₁=1.58, 95% CI 1.47 to 1.69; RRR=1.73), though remaining elevated compared with administrative workers. Social welfare occupations also experienced a statistically significant risk reduction (HR₂₀₂₀=1.62, 95% CI 1.42 to 1.85; HR₂₀₂₁=1.32, 95% CI 1.21 to 1.44; RRR=1.23). Bank clerks changed from slightly elevated risk to below the reference (HR₂₀₂₀=1.23, 95% CI 0.93 to 1.63; HR₂₀₂₁=0.76, 95% CI 0.62 to 0.94; RRR=0.85). Conversely, HRs for sales occupations increased between 2020 and 2021 (HR₂₀₂₀=1.04, 95% CI 0.92 to 1.18; HR₂₀₂₁=1.23, 95% CI 1.14 to 1.33; RRR=0.85). Several occupations maintained stable elevated risks, including bus drivers, meat processing workers and personal care workers.

We observed a risk reduction in some sectors, particularly healthcare, likely due to vaccination and protective measures. However, certain occupations maintained elevated risks, perhaps due to unavoidable close physical contact. These findings suggest the need for sector-specific approaches to occupational health protection and permanent structural changes in workplace organisation for future pandemic preparedness.