8281593 Gender and migration background disparities in COVID-19: exploring the role of essential work in France

Introduction Women, immigrants, and ethno-racial minorities have been disproportionately infected by COVID-19, with essential workers among the most impacted occupational groups. This study examines disparities in SARS-CoV-2 seropositivity by gender and migration background in France at the end of 2020, exploring the role of essential worker status. Methods We analyzed data from the EpiCoV cohort, including workers aged 18–64 in metropolitan France who completed home-based SARS-CoV-2 serology testing (ELISA) in late 2020. Participants were grouped by gender and migration background into mainstream men, mainstream women, non-mainstream men, and non-mainstream women. Worker status included seven categories: non-essential workers; high- and low-class healthcare workers (HCWs), high- and low-class social and educational workers (SEWs), and high- and low-class other essential workers (OEWs). We assessed seroprevalence across gender and migration background groups. Non-linear decomposition analysis was used to explain seropositivity differences between mainstream men and each of the other subgroups, distinguishing between compositional differences (unequal representation in essential occupations) and association differences (varying infection risk within similar essential occupations). Results SARS-CoV-2 seropositivity was lowest among mainstream men, higher among mainstream women, and highest among non-mainstream groups. The elevated seropositivity in mainstream women, compared to mainstream men, was partly explained by their overrepresentation among HCWs and the stronger association between low-class HCW status and COVID-19 risk. For non-mainstream women, higher seropositivity was partly attributable to their concentration in HCW and low-class SEW jobs, and the stronger association of low-class essential work statuses with seropositivity. Differences between mainstream and non-mainstream men and residual gender gaps were likely driven by factors beyond essential worker status. Discussion Essential worker status, particularly in lower occupational classes, explained some COVID-19 disparities, highlighting how gender and migration background intersect with job roles to shape infection risk. These findings call for protecting workers who combine social disadvantages with high-risk job roles.