The risk of dying during working ages (25 to 64) is high, rising, and unequal in the United States. Working-age mortality rates are much higher in some states than others. Part of the explanation may relate to differing policies across states that affect health. While some states enact policies that invest in people’s economic, social, and behavioral wellbeing, others enact policies that are potentially harmful to health. Using mortality data from the U.S. Centers for Disease Control and Prevention, this study examined how state policies on criminal justice, taxes, environment, firearms, marijuana, health care, labor, and tobacco were associated with the risk of dying among working-age adults from 2000 to 2019. The authors also estimated how changing these policies across a liberal-to-conservative continuum might affect the risks of dying from any cause and from cardiovascular disease (CVD), suicide, alcohol, and drug poisoning. The authors found that more conservative marijuana policies and more liberal policies on firearms, labor, environment, taxes, and tobacco were related to lower risk of death among working-age adults. Simulations show that changing all eight state policy domains 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. Fixing the high and rising mortality among working-age adults requires state policymakers to enact policies that provide a foundation for all Americans to achieve economic, social, and behavioral wellbeing.

Document Type

Research Brief


State Policies, Population Health


Public Affairs, Public Policy and Public Administration | Social and Behavioral Sciences | Sociology






This study was supported by a research grant from the National Institute on Aging (NIA R01AG055481), and this brief was supported by a grant (NIA P30 AG066583) to the Center for Aging and Policy Studies.


National Institute on Aging, Center for Aging and Policy Studies

Funding ID

NIA R01AG055481, NIA P30 AG066583

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.