State Adoption of Paid Sick Leave and Cardiovascular Disease Mortality Among Adults Aged 15-64 in the United States, 2008 to 2019

BackgroundCardiovascular Disease (CVD) is the leading cause of death in the United States and may be prevented through improved working conditions. The United States is one of the few high-income nations that does not guarantee paid sick leave (PSL) at the federal level. Our objective was to examine the relationship between state-level PSL policies and CVD mortality. MethodsWe used quasi-experimental event study methods to examine the relationship between implementing a mandatory PSL policy for all employees at the state-level and county-level CVD mortality rates using National Center for Health Statistics data among working-age adults aged 15 to 64 over time from 2008 to 2019. During this time, 11 states implemented PSL policies. We examined the annual CVD mortality rates (2008-2019) in 1054 counties from all 50 states and Washington D.C., accounting for approximately 88% of the United States population in this analysis. ResultsWe found that in the Northeastern region of the United States, there were drops in the CVD mortality rate for persons ages 15-64 for all years after PSL was implemented, ranging from 7.1 fewer deaths per 100,000 persons ({beta}=-7.1, 95% CI = -9.7, -4.4) seven years post-treatment to 2.7 fewer deaths two years post-treatment ({beta}=-2.7, 95% CI= -5.1, -0.3). ConclusionOur results support the use of state-level PSL policies to reduce county-level CVD mortality rates, especially in the Northeastern United States.