Essential worker status, gender, and migration background disparities in COVID-19: An intersectional approach

• SARS-CoV-2 seropositivity was greater in women and those with migration background • Essential worker status explained part of women’s higher infection risk • Women were over-represented in health, social, and educational essential jobs • Women also had a higher within-job infection risk in some low-class essential jobs • This dual burden in women was intensified by migration background COVID-19 disproportionately hit women, immigrants, ethno-racial minorities, and essential workers. This study examines disparities in SARS-CoV-2 seropositivity by gender and migration background in France (late 2020) and assesses how much essential worker status explains them. We grouped 30,018 workers from the EpiCoV cohort into four categories defined by gender and migration background. Worker status included seven categories: non-essential workers; high- and low-class healthcare workers (HCWs), social and educational workers (SEWs), and other essential workers (OEWs). We assessed SARS-CoV-2 seroprevalence across gender and migration-background groups. Non-linear decomposition analysis quantified the extent to which significant seropositivity differences were driven by unequal representation in essential occupations and varying infection risk within similar essential occupations. SARS-CoV-2 seropositivity was lowest among men without a migration background, higher among women without a migration background, and highest among individuals with a migration background. Compared to men without a migration background, seropositivity was 1.6 percentage points higher among women without a migration background (43.7% attributed to overrepresentation among HCWs and 5.8% to greater risk within low-class HCWs), and 6.9 percentage points higher among women with a migration background (31.5% driven by their overrepresentation among HCWs and low-class SEWs, and 19.4% by stronger risks across low-class essential jobs). The 5.3-point seropositivity gap between women with and without a migration background was 33.4% attributable to stronger infection risks among low-class SEWs and low-class OEWs. Women bore a double burden exacerbated by their migration background: overrepresentation in certain essential jobs and elevated COVID-19 risk within these occupations.