Introduction Occupations vary with respect to workplace factors that influence exposure to COVID-19, such as ventilation, social contacts and protective equipment. Variations between women and men may arise because they have different occupational roles or behavioural responses. We estimate occupational differences in COVID-19 hospital admission and mortality risks by sex.

Methods We combined individual-level data from 2011 Census with (i) health records and (ii) household-level information from residential identifiers. We used data for a cohort of 1.7 million Scottish adults aged 40-64 years between 1 March 2020 and 31 January 2021. We estimated age-standardised COVID-19 hospital admission and mortality rates, stratified by sex and occupation. Using Cox proportional hazards models, we estimated COVID-19 hospital admission and death risks, adjusting for relevant factors.

Results Generally, women had lower age-standardised COVID-19 hospital admission and mortality rates compared to men. Among women, adjusted death risks were lower for health professionals, and those in associate professional and technical occupations (paramedics and medical technicians). Among men, elevated adjusted admission and death risks were observed for large vehicle and taxi drivers. Additionally, admission risks remained high among men working in caring personal services, including home and care workers, while elevated risks were observed among women working in customer service occupations (call centre operators) and as process, plant and machine operatives (assemblers/sorters).

Conclusion Occupational differences in COVID-19 hospital admission and mortality risks between women and men highlight the need to account for sex differences when developing interventions to reduce infections among vulnerable occupational groups.

The authors have declared no competing interest.

The study was funded by UK Research Innovation Economic and Social Research Council (Grant numbers ES/W010321/1, ES/S007407/1 and ES/R005729/1). The study used data assets made available by National Safe Haven as part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research Innovation (Grant numbers MC_PC_20029 and MC_PC_20058).

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The College of Social Sciences Research Ethics Committee of University of Glasgow gave ethical approval (400200099). The Scottish Public Benefit and Privacy Panel for Health and Social Care and the Statistics Benefit and Privacy Panel gave approval for data linkage (2021-0119).

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