Associations of State Mandatory Paid Sick Leave Policies With Cancer Outcomes in the United States

Since 2012, several states have implemented mandatory paid sick leave (PSL) policies. PSL can provide patients time and income continuity to undergo screening and/or timely diagnostic workup for new cancer-related symptoms and complete lengthy and expensive cancer treatment courses. This study aimed to examine the association between mandatory PSL policies and cancer stage at diagnosis and overall survival (OS).

Adults age 18-64 years diagnosed with cancer were identified from the Surveillance, Epidemiology, and End Results program registries between 2010 and 2019. Difference-in-differences (DID) analyses were used to compare absolute changes in stage I and stage IV diagnoses and 1-year OS before and after policy implementation in states that enacted mandatory PSL relative to states that did not enact such policies.

A total of 1,052,307 patients with cancer were included. In adjusted DID analyses, there were a 0.83 (95% CI = -1.49 to -0.16, P = .014) PP decrease in stage IV diagnoses and a 0.63 (95% CI = 0.10 to 1.17, P = .021) PP increase in 1-year OS associated with implementation of mandatory PSL policies. In exploratory analyses, males and individuals with lung cancer experienced the greatest shifts in policy-associated changes in stage at diagnosis and OS.

PSL policy implementation is associated with decreased late-stage diagnoses and improved OS in patients with cancer. Policies that improve opportunities to receive medical care may facilitate earlier cancer detection and ultimately contribute to better patient outcomes.