Higher risk of COVID-19 hospitalization for unemployed: an analysis of 1,298,416 health insured individuals in Germany

Background: Previous research on infectious disease has revealed that infection risk as well as the severity of diseases is related to income and poverty. In this study we investigate if unemployed persons have a higher risk to become hospitalized with a COVID-19 diagnosis compared with employed persons. Methods: We used routine data on hospitalizations in a study population of 1,298,416persons between the ages 18 and 65 who were enrolled in a German health insurance and who were active on the labour market (either employed or unemployed). Hospital diagnosis of COVID-19 (ICD-10-GM U07.1 and U07.2) were reported on a daily basis from 01.01.2020 to 04.06.2020. We studied if the rate of persons hospitalized with a COVID-19 diagnoses differed by employment situation. Logistic regression models comparing employed with short- and long-term unemployed were calculated adjusting for age and sex. Results: In total, we observed 1,311 persons who were hospitalized, corresponding to a rate of 100.98 cases per 100.000 in our study population. Rates varied between the groups in different employment situations with lowest rates for employed and highest for long-term unemployed. Odds ratio for a hospitalization was 1.84 (1.64 - 2.07) for long-term and 1.18 (0.75 - 1.85) for short-term unemployed compared with employed persons. Conclusion: The results are in line with earlier (mainly ecological) studies from the USA and Great Britain which found social inequalities in hospitalization risk. The fact that differences exist in Germany, a country with a universal health care system, indicates socioeconomic differences in the COVID-19 pandemic exists across countries.