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U.S. state policy contexts and mortality of working-age adults

Jennifer Karas Montez, Nader Mehri, Shannon M. Monnat, Jason Beckfield, Derek Chapman, Jacob M. Grumbach, Mark D. Hayward, Steven H. Woolf, Anna Zajacova

PLOS ONE, October 2022

Jennifer Karas Montez

Jennifer Karas Montez

Shannon Monnat

Shannon Monnat

The rise in working-age mortality rates in the United States in recent decades largely reflects stalled declines in cardiovascular disease (CVD) mortality alongside rising mortality from alcohol-induced causes, suicide, and drug poisoning; and it has been especially severe in some U.S. states.

Building on recent work, this study examined whether U.S. state policy contexts may be a central explanation. We modeled the associations between working-age mortality rates and state policies during 1999 to 2019.

We used annual data from the 1999–2019 National Vital Statistics System to calculate state-level age-adjusted mortality rates for deaths from all causes and from CVD, alcohol-induced causes, suicide, and drug poisoning among adults ages 25–64 years. We merged that data with annual state-level data on eight policy domains, such as labor and taxes, where each domain was scored on a 0–1 conservative-to-liberal continuum.

Results show that the policy domains were associated with working-age mortality. More conservative marijuana policies and more liberal policies on the environment, gun safety, labor, economic taxes, and tobacco taxes in a state were associated with lower mortality in that state.

Especially strong associations were observed between certain domains and specific causes of death: between the gun safety domain and suicide mortality among men, between the labor domain and alcohol-induced mortality, and between both the economic tax and tobacco tax domains and CVD mortality.

Simulations indicate that changing all policy domains in all states to a fully liberal orientation might have saved 171,030 lives in 2019, while changing them to a fully conservative orientation might have cost 217,635 lives.