Workers of color in 'critical occupations' died at higher rates during COVID, University of Minnesota study finds

Workers in critical occupations were more likely to die during the first two years of the COVID-19 pandemic than other workers — and workers of color died at the highest rate of all — according to a new study from the University of Minnesota.

The study differs from several previous COVID surveys by using occupations to identify vulnerable populations, said Harshada Karnik, the study's lead author.

The study, published in October in the American Journal of Public Health, looked at the "excess mortality rate" of Minnesota workers in critical occupations. Researchers tracked deaths of all kinds, not just COVID deaths, because the pandemic affected other parts of life and health care that could have contributed to mortality.

Excess mortality rate refers to "deaths in excess of what they would be in normal circumstances," said Karnik, a researcher at the U's School of Public Health.

The study compared the differences in death rates from 2020 and 2021 with the death rates in 2017-19, before the pandemic began.

Seven U researchers spent two years on the study, which used the Cybersecurity and Infrastructure Security Agency's definition of "critical occupations" to identify jobs critical to keeping the nation's infrastructure afloat. They include jobs in health care, agriculture, food processing and food service, among others.

Other critical occupations analyzed in the study include emergency and first responders, and workers in child care, K-12 schools, manufacturing, construction and retail.

In total, the excess mortality rate for critical workers in Minnesota was 3 deaths for every 10,000 people in 2020, and 4.5 deaths for every 10,000 people in 2021.

For critical workers of color, the excess mortality rate was 4.6 in 2020 and 5.6 in 2021. Critical workers who were white experienced excess mortality rates of 2.7 in 2020 and 4.4 in 2021.

One of the most glaring differences came with workers in the transportation and logistics sector, which includes public transit, airports and the Postal Service, as well as logistics, delivery and infrastructure transportation.

In 2021, workers of color in that sector experienced an excess mortality rate of 11.6 deaths per every 10,000 workers, while white workers in the same industries experienced an excess mortality rate of 0.7 deaths per 10,000 workers.

The study did not examine the potential causes of the racial discrepancies in its findings.

The study counted deaths from all causes, using death certificates from the Minnesota Department of Health and population data from the U.S. Census Bureau's American Community Survey.

Karnik said the study included deaths of all causes, because not all COVID deaths were properly recorded as such during the first several months of the pandemic in 2020.

She added that indirect factors of the pandemic — such as overloaded hospitals — meant that many people suffering from other ailments such as cancer or overdoses couldn't get properly treated, likely influencing the increased excess mortality rate.

Statewide, COVID was the third-highest cause of death in 2020 and 2021 after cancer and heart disease, according to the Minnesota Health Department and the U.S. Centers for Disease Control and Prevention.

The findings that critical workers died at higher rates than noncritical workers, and that critical workers of color died at higher rates than their white counterparts, didn't come as a surprise to the study's authors. But other findings did, Karnik said, referring particularly to how some critical jobs were more deadly than others.

For example, food processing and food production work saw a higher excess mortality rate than health care and agricultural jobs.

Food processing, which includes meatpackers and commercial bakery workers, saw the highest excess mortality rate overall at 9.2 for every 10,000 workers in 2020. Critical workers of color saw the highest excess mortality rates in the food processing, food service, construction, retail and transportation industries.

Overall, the study found lower excess mortality rates for critical workers in the health care and first responder industries compared with other jobs. Karnik said the findings suggest that some industries did a better job protecting their workers from COVID through efforts like vaccination and providing personal protective equipment.

"What it means is that we have some sectors like food processing and food retail that can learn from the health care sector about protecting its workers," she said.

The findings have policy implications beyond COVID or even a future pandemic, Karnik added. Public health policymakers can use this type of data to conduct place-based intervention, when decisionmakers provide services by connecting with people in the workplace or wherever they are.

"Let's say there are public programs available where participation isn't good," she said. "One way to find people would be to reach them from their occupation. If we can identify where people are working, it's easier to reach them with other services."

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