Increasing paid sick leave linked to lower mortality in men and women

Key Takeaways:

• Mortality rates could decline by more than 5% in large central metropolitan counties with a 40-hour annual paid sick leave requirement.
• Homicide mortalities could be reduced by more than 13% in women and nearly 8% in men if counties without mandated paid sick leave began requiring employers to offer 40 hours of paid sick leave.
• Additional causes of death could also be minimized with increased paid sick leave: women could see a 16% reduction in alcohol-related deaths and an 8% reduction in suicides, while men could see a 4% reduction in suicides.

Access to paid sick leave was associated with lower mortality rates among men and women in the United States, according to a study published in the American Journal of Preventive Medicine.

“The proliferation of preemption laws has been called a ‘significant and quiet threat to public health.’ This study supports that warning,” Douglas A. Wolf, PhD, a professor at the Aging Studies Institute at Syracuse University, and colleagues wrote. “Mortality may decline by more than 5% in large central metropolitan counties currently constrained by preemption laws if they were able to mandate a 40-hour annual paid sick-leave requirement.”

With no national paid sick leave (PSL) mandate, the researchers noted that incorporating one could result in potential health benefits for workers. In 2020, 25% of private industry workers and 22% of civilian workers had no access to PSL, according to the Bureau of Labor Statistics.

“Lack of PSL 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,” Wolf and colleagues wrote. “PSL can also produce positive spillover impacts on healthy workers by reducing exposure to sick colleagues.”

Mortality among working-age adults has increased in recent decades, according to the researchers. They reported that between 2010 and 2017, mortality rates increased by 6% in this group, a rise that did not affect children, adolescents or older adults.

The researchers conducted a study to investigate how state preemption laws that prohibit local authorities from mandating paid sick leave or raising the minimum wage impact mortality rates. The analysis included mortality data from the CDC’s National Vital Statistics System on adults aged 25 to 64 years between 1999 and 2019.

Wolf and colleagues estimated that, in women, 1 hour of PSL was associated with a 0.2% reduction in homicide (RR = 0.998; 95% CI, 0.996-0.999) and a 0.4% reduction in alcohol-related deaths (RR=0.996; 95% CI=0.993, 0.999).

For men, 1 hour of PSL was associated with a 0.1% reduction in suicide (RR=0.999; 95% CI, 0.998-0.999) and a 0.2% reduction in homicide (RR = 0.998; 95% CI, 0.996-0.999).

“The decreases are sizable compared with those at a zero-hours baseline; for example, according to the models, moving from 0 to 40 hours of PSL would decrease homicide mortality by more than 13% among women and by nearly 8% among men,” Wolf and colleagues wrote.

Among other findings, the researchers noted a surprising lack of effect of minimum wage on causes of death, a contrast to previous research and hypothesis.

The “crux” finding, according to Wolf and colleagues, was the power that state legislatures hold in preventing health consequences among working-age adults.

“Several cities and counties have tried to raise their [minimum wage] or mandate PSL but only to have their state legislatures react by preempting their authority to do so,” the researchers wrote. “These findings indicate that the preemption laws have the potential to exert adverse consequences on working-age mortality.”

In four counties that had PSL mandates rejected, “the models predict that had they been allowed to implement their PSL requirement, deaths by homicide, suicide, and alcohol poisoning would have been 7.5% lower in 2019,” they wrote.

Overall, the findings underline the continual hinderance of preemption laws across the country, the authors argued, pointing to similar conduct regarding COVID-19 protocols and mandates.

“States such as Florida, Texas and Georgia overrode local authority to contain the virus's spread through mask mandates, social distancing orders, school closings and more,” they concluded. “The consequences of preemption laws are potentially profound. They stymie local government innovation, constrain opportunities to earn a living wage and take time off from work for medical care without financial repercussions, elevate the risks of death among infants and working-age adults, and contribute to geographic disparities in mortality.”

References:

• Access to paid sick leave linked to lower mortality rate among US adult workers. https://www.eurekalert.org/news-releases/962891. Published Aug. 29, 2022. Accessed Sep. 1, 2022.
• Paid sick leave: What is available to workers? https://www.bls.gov/ncs/ebs/factsheet/paid-sick-leave.htm. Accessed Sep. 2, 2022.
• Wolf D, et al. Am J Prev Med. 2022;doi:10.1016/j.amepre.2022.06.005.