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McCormack G, Avery C, Spitzer AK, Chandra A. Economic Vulnerability of Households With Essential Workers. JAMA. 2020;324(4):388–390. doi:10.1001/jama.2020.11366
The label of “essential worker” reflects society’s needs but does not mean that society has compensated those workers for additional risks incurred on the job during the current pandemic. When an essential worker contracts severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), they pose a risk to the other members of their household. These members may be elderly or lack health insurance, and the household may have limited resources to care for a sick family member.1,2 We assessed the proportion of essential workers in the US population and described the economic vulnerability of their households.
We analyzed data from the Public Use Microdata Sample of the 2018 American Community Survey (ACS). The US Census Bureau chooses a random sample of US addresses each month, contacts selected households by mail, and follows up by phone and personal visit to address nonresponse.3 The Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency (CISA) released an “Essential Critical Infrastructure Workforce” advisory list of occupations necessary to “continuity of functions critical to public health and safety” in March 2020 and updated that list in April 2020.4 We matched industry and subindustry codes in the ACS to the 6-digit Standard Occupation Codes (indexed by the US Bureau of Labor Statistics) in the CISA advisory list to identify essential workers.5 We assessed the proportion and demographic characteristics (age, sex, and race as given in response to a multiple-choice question) of essential workers by industry.
We defined 3 risk categories to estimate the economic vulnerability of households: (1) low household income (below $40 000); (2) uninsurance (at least 1 person in the household is uninsured); and (3) household presence of 1 or more persons aged 65 years or older. We categorized households facing at least 2 of these 3 risks to be high risk and examined the prevalence of risk in households with essential workers by industry. The data were weighted to be nationally representative. We used Stata version 16.0 (StataCorp) for all analyses. The Harvard University institutional review board does not require formal review for analysis of public use data.
A total of 3 214 539 individuals responded to the ACS in 2018 (response rate, 92.0%)6; we estimated that 101 188 748 of them were essential workers. As shown in Table 1, essential workers were estimated to comprise 40% of the US adult population. Of essential workers, 46% were female, 14% were black, 17% were Hispanic, 11% were uninsured, and 8% were aged 65 years or older. Eight of the 21 industry categories from the ACS accounted for 73% of essential workers. Health care accounted for a larger proportion (15%) of essential workers than any other industry: 65% of health care workers held essential jobs. Black individuals were overrepresented in several essential industries, notably transportation (23%), public administration (18%), and health care (18%).
A total of 1 410 976 households were represented in the 2018 ACS with an estimated 51% of those households including an essential worker. Table 2 summarizes household characteristics of essential workers: 25% of essential workers were estimated to have low household income, 18% to live in a household with at least 1 uninsured person, and 18% to live with someone aged 65 years or older. We estimated that 48% of essential workers lived in a household with at least 1 risk and 13% of essential workers lived in high-risk households.
Using 2018 data, an estimated 40% of US adults would be categorized as essential workers during the current pandemic, with 13% living in high-risk households. One limitation of the study is that the definition of high risk was developed for this study and may not match other studies or comprehensively capture true risk. In addition, some jobs expose essential workers to greater risk than others. Policies to support workers who are putting themselves and their families at risk to benefit others should be considered, and there is urgent need for economic analyses of the costs and benefits of approaches such as stimulus payments, short-term health care coverage, and prioritized testing.
Corresponding Author: Amitabh Chandra, PhD, Harvard Kennedy School, 79 JFK St, Cambridge, MA 02138 (firstname.lastname@example.org).
Accepted for Publication: June 10, 2020.
Published Online: June 18, 2020. doi:10.1001/jama.2020.11366
Author Contributions: Ms McCormack 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: All authors.
Acquisition, analysis, or interpretation of data: McCormack, Spitzer, Chandra.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: Avery, Spitzer, Chandra.
Statistical analysis: McCormack, Spitzer, Chandra.
Administrative, technical, or material support: Avery.
Supervision: Avery, Chandra.
Conflict of Interest Disclosures: Ms McCormack reported a fellowship with the National Institute on Aging (NIA) during the conduct of the study. Dr Chandra reported serving on the Congressional Budget Office’s Panel of Health Advisors. No other disclosures were reported.
Funding/Support: This research was funded by NIA grant T32-AG000186.
Role of the Funder/Sponsor: The NIA had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.