Well-Being Longevity

Paid sick leave associated with lower mortality rates among US workers

“State preemption laws that protect profits over people may be shortening the lives of working-age Americans.”
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Story at a glance


  • The United States currently does not enforce any paid sick leave policies at the national level.

  • Instead, these laws are decided at the state and local levels.

  • New research shows that mandatory paid sick leave policies are significantly linked with lower mortality rates among working age adults.

The United States is one of the only developed countries without a national paid sick leave policy, while preemption laws — or those that restrict lower governments’ legislative powers — have been on the rise. 

Although these laws were developed in part to create harmony among levels of government or establish minimum thresholds, new research published in the American Journal of Preventive Medicine outlines their unforeseen consequences. 

Between 2010 and 2017, findings show state laws preempting local officials from enacting mandatory paid sick leave likely contributed to the 6 percent mortality increase seen among working adults in that time frame, authors wrote. 

In areas where employers are required to provide paid sick leave, researchers found lower mortality rates among working age Americans. 


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Specifically, mandatory paid sick leave was associated with lower rates of suicide and homicide among men and lower homicide and alcohol-related mortality among women. Each individual hour of guaranteed paid sick leave was linked with significant reductions in these causes of death, researchers wrote.

For example, “moving from 0 to 40 hours of [paid sick leave] is predicted to decrease homicide mortality by more than 13% among women and by nearly 8% among men.” 

In the past, states have preempted local governments from raising the minimum wage or mandating paid sick leave policy, while these states “tend to be those that have experienced small gains in life expectancy and large increases in working-age mortality in recent decades,” authors wrote. 

After 2010, preemption use significantly expanded to cover labor standards, public health and other domains.

To carry out the study, researchers assessed cause and sex of county-by-quarter death counts between 1999 and 2019. Data were gleaned from the Centers for Disease Control and Prevention’s (CDC) National Vital Statistics System on individuals aged 25 to 64.

“State preemption laws that protect profits over people may be shortening the lives of working-age Americans,” said study co-author Jennifer Karas Montez of Syracuse University in a statement.

“We were surprised by how large the ‘preemption effect’ for paid sick leave mandates turned out to be. We project that mortality could potentially decline by over 5% in large central metro counties currently constrained by preemption laws if they were able to mandate a 40-hour annual paid sick leave requirement.”

In counties that were not permitted to enact paid sick leave mandates, researchers estimate mortality rates would have been 7.5 percent lower were they allowed to do so.

Notably, data were collected prior to the COVID-19 pandemic, which saw millions of working age Americans fall ill with the disease.

“Lack of [paid sick leave] increases the odds of economic hardship and involuntary job loss for those who take time off to recover, which in turn can elevate the odds of suicide, drug use, and other risky behaviors. [Paid sick leave] can also produce positive spillover impacts on healthy workers by reducing exposure to sick colleagues,” authors wrote.

Overall, preemption laws inhibit local government innovation and contribute to geographic mortality disparities, added co-author Douglas A. Wolf, also of Syracuse University.