<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To estimate occupational differences in COVID-19 mortality, and test whether these are confounded by factors, such as regional differences, ethnicity and education or due to non-workplace factors, such as deprivation or pre-pandemic health.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Retrospective cohort study</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>People living in private households England</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>14,295,900 people aged 40-64 years (mean age 52 years, 51% female) who were alive on 24 January 2020, living in private households in England in 2019, were employed in 2011, and completed the 2011 census.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>COVID-19 related death, assessed between 24 January 2020 and 28 December 2020. We estimated age-standardised mortality rates per 100,000 person-years at risk (ASMR) stratified by sex and occupations. To estimate the effect of occupation due to work-related exposures, we used Cox proportional hazard models to adjust for confounding (region, ethnicity, education), as well as non-workplace factors that are related to occupation.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>There is wide variation between occupations in COVID-19 mortality. Several occupations, particularly those involving contact with patients or the public, show three-fold or four-fold risks. These elevated risks were greatly attenuated after adjustment for confounding and mediating non-workplace factors. For example, the hazard ratio (HR) for men working as taxi and cab drivers or chauffeurs changed from 4.60 [95%CI 3.62-5.84] to 1.47 [1.14-1.89] after adjustment. More generally, the overall HR for men working in essential occupations compared with men in non-essential occupations changed from 1.45 [1.34 - 1.56] to 1.22 [1.13 - 1.32] after adjustment. For most occupations, confounding and other mediating factors explained about 70% to 80% of the age-adjusted hazard ratios.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Working conditions are likely to play a role in COVID-19 mortality, particularly in occupations involving contact with COVID-19 patients or the public. However, there is also a substantial contribution from non-workplace factors, including regional factors, socio-demographic factors, and pre-pandemic health.</jats:p></jats:sec>