Occupational factors strongly influence Long-COVID risk

A large Catalan cohort study shows that healthcare, social care, education, retail, and transport workers are at higher risk for Long-COVID 

Work-related factors play a significant and independent role in the risk of developing Long-COVID, shows a new study based on the COVICAT cohort and led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by "la Caixa" Foundation, in collaboration with the University of Turin and the Germans Trias i Pujol Institute (IGTP). The findings, published in BMJ Occupational & Environmental Medicine, highlight that a substantial share of Long-COVID could be prevented through targeted workplace measures and policies.

The public health impact of Long-COVID is far from over. Beyond ongoing infections that continue to cause illness and deaths worldwide, millions of people are living with lasting health consequences. Globally, around 6 in every 100 COVID-19 cases develop Long-COVID, amounting to 400 million affected people and an annual economic impact of roughly 1 trillion dollars, or 1% of the global economy.

"Occupational factors have been associated with incidence and severity of SARS-CoV-2 infection. But the occupational determinants of Long-COVID are largely unknown," explains Kurt Straif, ISGlobal researcher and study coordinator. This knowledge gap motivated the researchers to explore whether work environments and occupations influence Long-COVID risk based on data from COVICAT, a population cohort established in Catalonia at the beginning of the pandemic.

The analysis included 2,054 employed adults from the COVICAT cohort who had a confirmed SARS-CoV-2 infection, were aged 18-70 years at baseline, answered all three follow-up surveys (2020-2023) and provided complete occupational information. Of these, 486 participants (23.7%) developed Long-COVID. Most presented neurological symptoms (64%), followed by musculoskeletal (38%) and respiratory symptoms (28%).

Key risk factors: who is most vulnerable?

Individual factors associated with higher Long-COVID risk included being female, having low educational level, obesity, multiple comorbidities, and experiencing more frequent or more severe SARS-CoV-2 infections. In contrast, COVID-19 vaccination prior to the infection, being first infected by Omicron, and older age were protective.

Occupation also emerged as a strong and independent determinant. Workers in high-risk occupations for COVID-19 had a 44% higher likelihood of developing Long-COVID, compared with low-risk jobs. Working onsite rather than teleworking increased risk by 57%; infrequent or inconsistent use of FFP2/FFP3 masks increased it by up to 52%; and commuting regularly by public transport raised it by 58%. The group of occupations with the highest Long-COVID risk scores included healthcare and social care professionals, teachers, retail workers, transport workers, and security staff.

"These results are consistent with emerging international evidence and suggest several mechanisms through which occupational exposures may shape Long-COVID development," says Sara de Matteis, researcher at the University of Turin and first author of the study. Possible mechanisms include increased viral exposure in jobs with high patient and public contact and weakened immune responses due to high physical demands or work-related stress.

Implications for prevention and policy

The findings reinforce the need for workplace measures, such as adequate personal protective equipment, mask use, and strategies to reduce close contact, not only for preventing infection, but also for mitigating long-term health consequences.

"Because occupational risk factors are modifiable, our findings mean that much of the associated Long-COVID burden could be avoided with targeted measures," says Manolis Kogevinas, ISGlobal researcher and study co-author. The authors call for strengthened COVID-19 vaccination campaigns, the provision of FFP2/FFP3 masks, and regular health checks for high-risk occupations. They also urge policymakers to expand recognition and compensation for occupational Long-COVID.

This study is the result of a joint effort by ISGlobal, IGTP, and the University of Turin. It draws on data from the COVICAT cohort, part of the GCAT project-a large Catalan population cohort coordinated by IGTP - which, since 2020 and in coordination with ISGlobal, is leading a dedicated follow-up study to assess the long-term effects of COVID-19.

Reference

De Matteis S, Consonni D, Espinosa A, de Cid R, Blay N, Castaño-Vinyals G, Karachaliou M, Alba Hidalgo MA, Papantoniou K, Garcia J, Kogevinas M, Straif K. Occupational determinants of Long-COVID in the population-based COVICAT cohort. 2025. BMJ OEM. DOI:10.1136/oemed-2025-EPICOHabstracts.140