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U.S. State Preemption Laws and Working-Age Mortality

Sep 1, 2022

U.S. State Preemption Laws and Working-Age Mortality

Douglas Wolf, Jennifer Karas Montez, Shannon Monnat

American Journal of Preventive Medicine, August 2022

Douglas A. Wolf

Douglas A. Wolf


Jennifer Karas Montez

Jennifer Karas Montez


Shannon Monnat

Shannon Monnat


The goal of this study was to estimate how state preemption laws that prohibit local authority to raise the minimum wage or mandate paid sick leave have contributed to working-age mortality from suicide, homicide, drug overdose, alcohol poisoning, and transport accidents.

County-by-quarter death counts by cause and sex for 1999–2019 were regressed on minimum wage levels and hours of paid sick-leave requirements, controlling for time-varying covariates and place- and time-specific fixed effects. The model coefficients were then used to predict expected reductions in mortality if the preemption laws were repealed. Analyses were conducted during January 2022–April 2022.

Paid sick-leave requirements were associated with lower mortality. These associations were statistically significant for suicide and homicide deaths among men and for homicide and alcohol-related deaths among women. 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.

State legislatures’ preemption of local authority to enact health-promoting legislation may be contributing to the worrisome trends in external causes of death.