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Background <p>The COVID-19 pandemic exposed global health disparities shaped by demographic, social, and health-related factors. Occupational status is one potential determinant of both infection risk and disease progression. This study examines whether higher occupational status, specifically being in a supervisor or manager role, influenced the risk of developing COVID-19 and explores the mediating role of pre-existing diseases.</p> Methods <p>A population-based longitudinal study was conducted using anonymized claims data from German health insurance providers. Age-standardized COVID-19 incidence rates in 2020 and 2021 were compared across pandemic waves between individuals in supervisor or manager roles and those in non-supervisory positions, stratified by pre-existing disease status. Regression and causal mediation analyses assessed the relationships among occupational status, pre-existing diseases, and COVID-19 incidence.</p> Results <p>Female supervisors and managers had a significantly lower risk of COVID-19 (RR 0.85; 95% CI 0.82–0.89). More broadly, supervisory roles were associated with reduced COVID-19 incidence. Pre-existing diseases explained roughly 5% of the protective association between higher occupational status and lower disease risk.</p> Conclusion <p>The results underscore the relevance of socioeconomic inequalities during the pandemic. Contrary to prior assumptions, pre-existing conditions accounted for only a minor share of the observed differences in COVID-19 risk by occupational status. Other factors likely contribute more substantially, emphasizing the value of targeted mediation analyses to clarify the nature and direction of these complex relationships.</p>

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Do pre-existing diseases explain the association between occupational status and COVID-19 illness? A mediation analysis based on claims data

  • 期刊论文

  • 发表日期：

    2026年2月25日

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  • Alibone Marco,
  • Meyer Kubi,
  • Beese Florian,
  • Robert Gutu,
  • Dragano Nico,
  • Benjamin Wachtler

摘要

Background

The COVID-19 pandemic exposed global health disparities shaped by demographic, social, and health-related factors. Occupational status is one potential determinant of both infection risk and disease progression. This study examines whether higher occupational status, specifically being in a supervisor or manager role, influenced the risk of developing COVID-19 and explores the mediating role of pre-existing diseases.

Methods

A population-based longitudinal study was conducted using anonymized claims data from German health insurance providers. Age-standardized COVID-19 incidence rates in 2020 and 2021 were compared across pandemic waves between individuals in supervisor or manager roles and those in non-supervisory positions, stratified by pre-existing disease status. Regression and causal mediation analyses assessed the relationships among occupational status, pre-existing diseases, and COVID-19 incidence.

Results

Female supervisors and managers had a significantly lower risk of COVID-19 (RR 0.85; 95% CI 0.82–0.89). More broadly, supervisory roles were associated with reduced COVID-19 incidence. Pre-existing diseases explained roughly 5% of the protective association between higher occupational status and lower disease risk.

Conclusion

The results underscore the relevance of socioeconomic inequalities during the pandemic. Contrary to prior assumptions, pre-existing conditions accounted for only a minor share of the observed differences in COVID-19 risk by occupational status. Other factors likely contribute more substantially, emphasizing the value of targeted mediation analyses to clarify the nature and direction of these complex relationships.