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Saturday, April 18, 2026

U.S. State Preemption Laws and Working-Age Mortality - American Journal of Preventive Medicine

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.

Methods

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 The model coefficients were then used to predict expected reductions in mortality if the preemption laws were repealed.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.

Results

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.

Conclusions

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

Preemption laws, which constrain lower-level governments’ legislative powers, have long been used to harmonize federal, state, and local policymaking or to establish minimum thresholds.

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For instance, the federal...



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