A disproportionate epidemic: COVID-19 cases and deaths among essential workers in Toronto, Canada
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Abstract
Shelter-in-place mandates and closure of nonessential businesses have been central to COVID19 response strategies including in Toronto, Canada. Approximately half of the working population in Canada are employed in occupations that do not allow for remote work suggesting potentially limited impact of some of the strategies proposed to mitigate COVID-19 acquisition and onward transmission risks and associated morbidity and mortality. We compared per-capita rates of COVID-19 cases and deaths from January 23, 2020 to January 24, 2021, across neighborhoods in Toronto by proportion of the population working in essential services. We used person-level data on laboratory-confirmed COVID-19 community cases and deaths, and census data for neighborhood-level attributes. Cumulative per-capita rates of COVID-19 cases and deaths were 3.3-fold and 2.5-fold higher, respectively, in neighborhoods with the highest versus lowest concentration of essential workers. Findings suggest that the population who continued to serve the essential needs of society throughout COVID-19 shouldered a disproportionate burden of transmission and deaths. Taken together, results signal the need for active intervention strategies to complement restrictive measures to optimize both the equity and effectiveness of COVID-19 responses.
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Use of area-level income measure in absence of individual-level measures might result in an underestimation of social inequalities.
“Limitations include our use of a area-level income measure in the absence of individual-level measures, which might result in an underestimation of social inequalities(65).”
From Social inequalities in COVID-19 death by area-level income in 11.2 million people in Ontario, Canada: patterns over time and the mediating role of vaccination. (2026) · cites this paper as [65]
The Methods describe neighbourhood-level census attributes, and the Conclusions identify ecological-level measures as a limitation because they cannot establish individual-level associations. The paper does not say that using area-level income without individual-level income might underestimate social inequalities; that proposed consequence is unsupported. (LLM, conf=0.83)
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Research works printed but not linked: 2
- [11]Weill JA Stigler M Deschenes O Springborn MR. Social distancing responses to COVID-19 emergency declarations strongly differentiated by income Proc Natl Acad Sci U S A. 117 33 2020 19658 19660 32727905 PMC7443940
- [12]Chen YH Glymour M Riley A Balmes J Duchowny K Harrison R Excess mortality associated with the COVID-19 pandemic among Californians 18-65 years of age, by occupational sector and occupation: March through November 2020 PLoS One 16 6 2021 e0252454 PMC8177528 34086762
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Wang, L., Swayze, S., Bodner, K., Calzavara, A., Harrigan, S. P., Siddiqi, A., Baral, S. D., Austin, P. C., Smylie, J., Koh, M., et al. (2026) · American Journal of Epidemiology · doi:10.1093/aje/kwaf051 · Cited by 5 · see citing works
Self-citation
- Authors
- Rao, A., Ma, H., Moloney, G., Kwong, J. C., Jüni, P., Sander, B., Kustra, R., Baral, S. D., & Mishra, S.
- Affiliations
- Johns Hopkins University (US)
- St. Michael's Hospital (CA)
- University Health Network (CA)
- University of Toronto (CA)
- Corresponding author
- Mishra, Sharmistha
- ORCID
- Venue
- Annals of Epidemiology
- Publisher
- Elsevier BV
- Published
- 2021-11
- Volume
- 63
- Pages
- 63-67
- ISSN
- 1047-2797 (ISSN-L)
- PMC
- PMC8435380
- OpenAlex
- W3183672417
- Cited by
- 60
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 12 · 2023: 14 · 2022: 17 · 2021: 14
- FWCI
- 5.51
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Annals of Epidemiology (publishedVersion, cc-by-nc-nd)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (VR5-172683)
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Challenges
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- COVID-19 pandemic, essential workers, health disparities, COVID-19 mortality, COVID-19 cases, remote work, occupational exposure, Toronto
- MeSH terms
- COVID-19, SARS-CoV-2, Canada, Humans, Occupations, Epidemics
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