Abstract
Cardiovascular Disease (CVD) is the leading cause of death in the United States and may be prevented through improved working conditions. The United States 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. We used quasi-experimental event study methods proposed by Sun and Abraham to examine the relationship between implementing a mandatory PSL policy for all employees at the state-level and county-level CVD mortality among working-age adults aged 15 to 64 over time from 2008 to 2019. 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. We 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 adopted, ranging from 6.0 fewer deaths per 100,000 persons (β=-6.0, 95% CI = -10.1, -1.9) seven years post-treatment to 2.9 fewer deaths three years post-treatment (β=-2.9, 95% CI= -4.9, -0.9). We found no effect of PSL in the Western United States, and mixed effects in a nationwide analysis. Finally, the strong presence of pretreatment effects in the Western United States makes the results for that region uninterpretable. Our results support the use of state-level PSL policies to reduce county-level CVD mortality rates in the Northeastern United States.