State adoption of paid sick leave and cardiovascular disease mortality among adults in the United States, 2008-2019

Cardiovascular diseases (CVD) are 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. We used quasi-experimental event study methods to examine the relationship between state-level PSL policies and county-level CVD mortality among working-age adults aged 15 to 64 over time (2008 to 2019). We examined the annual CVD mortality rates in 1054 counties from all 50 states and Washington D.C.. In the Northeastern region of the United States, there were drops in the CVD mortality rate in all years after PSL was adopted. We found no effect of PSL in the Western United States with a strong presence of pretreatment effects, making 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.