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Outcomes of COVID-19 Among Hospitalized Health Care Workers in North America

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Are health care workers (HCWs) at risk of worse outcomes associated with coronavirus disease 2019 (COVID-19) compared with the general population?

Findings  This propensity-matched multicenter cohort study included 122 HCWs hospitalized with COVID-19 matched to 366 non-HCWs hospitalized with COVID-19. The odds of the primary outcome—mechanical ventilation or death—were not significantly different for HCWs compared with non-HCWs.

Meaning  This study finds that HCW status is not associated with poorer outcomes among patients hospitalized with COVID-19.


Importance  Although health care workers (HCWs) are at higher risk of acquiring coronavirus disease 2019 (COVID-19), it is unclear whether they are at risk of poorer outcomes.

Objective  To evaluate the association between HCW status and outcomes among patients hospitalized with COVID-19.

Design, Setting, and Participants  This retrospective, observational cohort study included consecutive adult patients hospitalized with a diagnosis of laboratory-confirmed COVID-19 across 36 North American centers from April 15 to June 5, 2020. Data were collected from 1992 patients. Data were analyzed from September 10 to October 1, 2020.

Exposures  Data on patient baseline characteristics, comorbidities, presenting symptoms, treatments, and outcomes were collected, including HCW status.

Main Outcomes and Measures  The primary outcome was a requirement for mechanical ventilation or death. Multivariable logistic regression was performed to yield adjusted odds ratios (AORs) and 95% CIs for the association between HCW status and COVID-19–related outcomes in a 3:1 propensity score–matched cohort, adjusting for residual confounding after matching.

Results  In total, 1790 patients were included, comprising 127 HCWs and 1663 non-HCWs. After 3:1 propensity score matching, 122 HCWs were matched to 366 non-HCWs. Women comprised 71 (58.2%) of matched HCWs and 214 (58.5%) of matched non-HCWs. Matched HCWs had a mean (SD) age of 52 (13) years, whereas matched non-HCWs had a mean (SD) age of 57 (17) years. In the matched cohort, the odds of the primary outcome, mechanical ventilation or death, were not significantly different for HCWs compared with non-HCWs (AOR, 0.60; 95% CI, 0.34-1.04). The HCWs were less likely to require admission to an intensive care unit (AOR, 0.56; 95% CI, 0.34-0.92) and were also less likely to require an admission of 7 days or longer (AOR, 0.53; 95% CI, 0.34-0.83). There were no differences between matched HCWs and non-HCWs in terms of mechanical ventilation (AOR, 0.66; 95% CI, 0.37-1.17), death (AOR, 0.47; 95% CI, 0.18-1.27), or vasopressor requirements (AOR, 0.68; 95% CI, 0.37-1.24).

Conclusions and Relevance  In this propensity score–matched multicenter cohort study, HCW status was not associated with poorer outcomes among hospitalized patients with COVID-19 and, in fact, was associated with a shorter length of hospitalization and decreased likelihood of intensive care unit admission. Further research is needed to elucidate the proportion of HCW infections acquired in the workplace and to assess whether HCW type is associated with outcomes.

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Article Information

Accepted for Publication: December 10, 2020.

Published: January 28, 2021. doi:10.1001/jamanetworkopen.2020.35699

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Yang JY et al. JAMA Network Open.

Corresponding Author: Nauzer Forbes, MD, MSc, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, 3280 Hospital Dr NW, TRW 6D19, Calgary, AB T2N 4Z6, Canada (nauzer.forbes@ucalgary.ca).

Author Contributions: Dr Forbes had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Yang, Parkins, Aroniadis, Yadav, Dixon, Elmunzer, Forbes.

Acquisition, analysis, or interpretation of data: Yang, Canakis, Aroniadis, Yadav, Forbes.

Drafting of the manuscript: Yang, Parkins, Forbes.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Yang, Forbes.

Administrative, technical, or material support: Parkins, Canakis, Dixon, Elmunzer.

Supervision: Elmunzer, Forbes.

Conflict of Interest Disclosures: Dr Forbes reported receiving personal fees from Boston Scientific and from Pentax Medical outside the submitted work. No other disclosures were reported.

Group Information: Members of the DMC-19 Study Group and the North American Alliance for the Study of Digestive Manifestations of COVID-19 are as follows: Authors: Jeong Yun Yang, MD, Icahn School of Medicine at Mount Sinai; Michael D. Parkins, MD, MSc, University of Calgary; Andrew Canakis, DO, Boston University Medical Center; Olga C. Aroniadis, MD, MS, Stony Brook Hospital; Dhiraj Yadav MD, MPH, University of Pittsburgh Medical Center; Rebekah E. Dixon BS, Icahn School of Medicine at Mount Sinai; B. Joseph Elmunzer, MD, MSc, Medical University of South Carolina; Nauzer Forbes, MD, MSC, University of Calgary. Data coordinating center: Rebecca L. Spitzer, MPH, Teldon B. Alford, BA, Lauren Wakefield, MHA, Haley Nitchie, MHA, Collins O. Ordiah, MBBS, all of the Medical University of South Carolina. Steering committee: B. Joseph Elmunzer, MD, MSc (chair), Don C. Rockey, MD, Rebecca L. Spitzer, MPH, Collins O. Ordiah, MBBS, all of the Medical University of South Carolina; Rebekah E. Dixon, BS, Christopher J. DiMaio, MD, both of the Icahn School of Medicine at Mount Sinai; Jennifer M. Kolb, MD, MS, Sachin Wani, MD, both of the University of Colorado; Olga C. Aroniadis, MD, MS, Stony Brook Hospital; Robin B. Mendelsoh, MD, Memorial Sloan Kettering Cancer Center; Amit G. Singal, MD, MS, University of Texas Southwestern; Amar R. Deshpande, MD, University of Miami Miller School of Medicine; Swati Pawa MD, Wake Forest University School of Medicine; Darwin Conwell, MD, MSC, Ohio State University Wexner Medical Center; Raman Muthusamy, MD, MAS, David Geffen School of Medicine at UCLA; William M. Tierney, MD, University of Oklahoma Health Sciences Center; Dhiraj Yadav, MD, MPH, University of Pittsburgh Medical Center. Clinical sites in order of number of patients contributed: Emory University: Ambreen A. Merchant, MBBS, Vaishali A. Patel, MD, Field F. Willingham MD, MPH. Vanderbilt University: Eric F. Howard, RN, BSN, Mary K. West, RN, BSN, Casey L. Koza BS, Patrick S. Yachimski, MD. Grady Memorial Hospital: Emad Qayed, MD, MPH, Rosemary Nustas, MD. Ascension Providence Hospital/Michigan State University: Ali Zakaria, MD, Marc S. Piper, MD, MSc. St Louis University: Jason R. Taylor, MD, Lujain Jaza, MD. University of Calgary: Nauzer Forbes, MD, MSc, Millie Chau, BSc. The Ohio State University Wexner Medical Center: Luis F. Lara, MD, Georgios I. Papachristou, MD, PhD, Uchechi Okafor, BSc, Darwin L. Conwell, MD, MSc. Loma Linda University: Michael L. Volk, MD, MSc, Evan Mosier, MD, Mohamed Azab, MD, Anish Pate, MD. University of Southern California: Liam G. Hilson, MD, Selena Zhou, MD, James Buxbaum, MD. Washington University School of Medicine: Vladimir M. Kushnir, MD, Alexandria M. Lenyo, BS, Ian P. Sloan, BS, Thomas Hollander, RN, BSN. Medical University of South Carolina: Caroline G. McLeod, BS, Rebecca L. Spitzer, MPH, Lauren Wakefield, MHA, Haley Nitchie, MHA, Collins O. Ordiah, MBBS, MPH, Don C. Rockey, MD, B. Joseph Elmunzer, MD. University of Miami Miller School of Medicine: Sunil Amin, MD, MPH, Gabriela N. Kuftinec MD, MPH, Amar R. Deshpande MD. University of Pittsburgh: Dhiraj Yadav, MD, MPH, Melissa Saul, MS, Melanie Mays, BS, Gulsum Anderson, PhD, Kelley Wood, BS, Laura Mathews, BS. University of Colorado: Charlie Fox, MD, Jennifer M. Kolb, MD, MS, Sachin Wani, MD. Wake Forest University School of Medicine: Swati Pawa, MD, Rishi Pawa, MD. Boston University: Andrew Canakis, DO, Christopher Huang, MD. Beaumont Health: Laith H. Jami, MD, Andrew M. Aneese, MD, V. Mihajlo Gjeorgjievski, MD, Zaid Imam, MD, Fadi Odish, MD, Ahmed I. Edhi, MD, Molly Orosey, DO, Abhinav Tiwari, MD, Soumil Patwardhan, MBBS. University Hospitals of Cleveland Medical Center: Benita K. Glamour, BA, Zachary L. Smith, DO, Amy E. Hosmer, MD, Nancy Furey, RN, BSN, MBA, Amitabh Chak, MD. Northwestern University Feinberg School of Medicine: Katherine A. Hanley, MMS, PAC, Jordan Wood, BS, Rajesh N. Keswani, MD, MS. Ochsner Health: Harsh K. Patel, MBBS, Janak N. Shah, MD. Columbia University Medical Center: Emil Agarunov, BS, Nicholas G. Brown, MD, Anish A. Patel, MD, Amrita Sethi, MD. Indiana University School of Medicine: Evan L. Fogel, MD, MSc, Gail McNulty, RN, BSN. Loyola University Medical Center: Abdul Haseeb, MD, Judy A. Trieu, MD. Icahn School of Medicine at Mount Sinai: Rebekah E. Dixon, BS, Jeong Yun Yang, MD, Christopher J. DiMaio, MD. Memorial Sloan Kettering Cancer Center: Robin B. Mendelsohn, MD, Delia Calo, MD. Renaissance School of Medicine at Stony Brook University: Olga C. Aroniadis, MD, MSc, Joseph F. LaComb, BS, Lilian Cruz, BS, Olga Reykhart, BS. University of Virginia Medical School: James M. Scheiman, MD, Bryan G. Sauer, MD, Galina Diakova, MS. Henry Ford Health System: Duyen T. Dang, MD, Cyrus R. Piraka, MD. Dartmouth-Hitchcock Health and VA White River Junction: Eric D. Shah, MD, MBA, Molly Caisse, BS, Natalia H. Zbib, MD, John A. Damianos, MD, Heiko Pohl, MD. University of Oklahoma Health Sciences Center: William M. Tierney, MD, Stephanie Mitchell, RN, Michael S. Bronze, MD. David Geffen School of Medicine at UCLA: Ashwinee Condon, MD, Adrienne Lenhart, MD, Raman Muthusamy, MD, MAS. Medical College of Wisconsin: Kulwinder S. Dua, MD, Vikram S. Kanagala, MD, James Esteban, MD. Johns Hopkins Medical Institutions: Ayesha Kamal, MD, Marcia I. Canto, MD, Vikesh K. Singh, MD, MS. McMaster University Hamilton Health Sciences: Maria Ines Pinto-Sanchez, MD, MSc, Joy M. Hutchinson, RD, MSc. Michigan Medicine: Richard S. Kwon, MD, Sheryl J. Korsnes, MA. University of Manitoba: Harminder Singh, MD, MPH, Zahra Solati, MSc, Nick Hajidiacos, MD.

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