Disparities in Access to Paid Sick Leave During the First Year of the COVID-19 Pandemic

Abstract

Objective 

This study sought to assess disparities in access to paid sick leave in the first year of the COVID-19 pandemic based on demographic and socioeconomic factors.

Methods 

The percentage of workers with access to paid sick leave was calculated according to age group, sex, race/ethnicity, educational attainment, region, health insurance coverage, receiving public assistance, income, occupation, and industry.

Results 

A total of 65.6% of workers had access to paid sick leave. Access was lowest among Hispanic workers, workers with less than a high school education, and workers without health insurance coverage.

Conclusions 

There were wide disparities in access to paid sick leave during the first year of the COVID-19 pandemic, which may be associated with disparities in the risk for COVID-19. The introduction of mandatory paid sick leave may serve to protect workers from the spread of infectious diseases.

In Brief

The findings from this study highlight how disparities in access to paid sick leave may be related to different risk for infectious disease, like COVID-19. Providing access to paid sick leave may be a method for preventing the spread of infectious diseases.

CME Learning Objectives

After completing this enduring educational activity, the learner will be better able to:

• Describe the impact of access to paid sick leave on the health of workers during the COVID-19 pandemic
• Assess the disparities in access to paid sick leave in the first year of the COVID-19 pandemic based on demographic and socioeconomic factors
• Outline the impact of disparities to paid sick leave-based age, education, race and gender

Unlike most other high-income countries, paid sick leave is not guaranteed for all workers in the United States.¹ The Family and Medical Leave Act does ensure unpaid sick leave to workers,² while some states have begun to introduce paid sick leave laws. Currently 16 states have either paid sick leave laws or laws about accrued time that can be used for sick leave.³ During the COVID-19 pandemic, the Families First Coronavirus Response Act made limited paid sick leave available to workers in the public sector and workers employed by employers with fewer than 500 workers. The law went into effect in mid-March and lasted through the end of 2020.⁴

Previous research has shown paid sick leave to have positive health impacts for workers. Paid sick leave may be associated with a lower risk of all-cause mortality,⁵ emergency department visits,⁶ psychological distress,⁷ occupational injuries,^8,9 opioid-overdoses, and suicide.^10–12 In addition, having 10 or more paid sick leave days has been found to increase the odds of using preventive healthcare services.¹³ Compared with workers with paid sick leave, workers without paid sick leave are less likely to take time off for illness or injury.¹⁴

The workplace was likely a venue for the spread of COVID-19.^15,16 However, there are disparities in access to paid sick leave throughout workplaces in the United States. One recent study found that in 2018, Black and Hispanic workers, as well workers in Midwestern and Southern states and workers with lower levels of educational attainment had lower access to paid sick leave.¹⁷ Older workers, especially those employed in healthcare support; building and grounds cleaning and maintenance; and transportation and material moving occupation have been found to lower access to paid sick leave compared with younger workers in those same occupations.¹⁸ This disparity is a major concern because of age being a leading risk factor for severe COVID-19. Even among workers with access to paid sick leave, different factors contribute to whether they use it including wanting to save leave time, leave denial, and concerns about job consequences including fear of job loss.¹⁹

These disparities in the access and use of paid sick leave may contribute to similar disparities in the risk for COVID-19 according to geography,²⁰ race/ethnicity,^21,22 and educational attainment.^23,24 There are also disparities in the risk of COVID-19 outcomes according to other factors that may be associated with access to paid sick leave access including occupation,^25,26 industry,²⁷ income,²⁸ and insurance status.^29,30 Research has suggested that the expansion of access to paid sick leave that came with the Families First Coronavirus Response Act may have resulted in reductions in the number of workers getting COVID-19.³¹ Similar research found that a large restaurant chain that provided access to paid sick leave during the pandemic had decreased the number of workers at the chain working while sick, compared with workers at other food service businesses that did not have access to paid sick leave.³² During the H1N1 pandemic, not having access to paid sick leave was associated with a higher probability of having had influenza-like illnesses.³³ City level paid sick leave policies were associated with a higher uptake of COVID-19 vaccines, ³⁴ suggesting a further pathway by which paid sick leave laws may be protective against COVID-19.

Because of evidence of the potential impact of paid sick leave on COVID-19 rates, historical evidence of disparities in access to paid sick leave, and disparities in COVID-19 during the pandemic among workers, understanding differences in access to paid sick leave in 2020 are particularly important. This information may be useful for informing policy changes with respect to paid sick leave. To gain insight in these issues, this study sought to assess access to paid sick leave in 2020. Specific factors examined in this study include age group, sex, race/ethnicity, educational attainment, region, health insurance coverage, receiving public assistance, income, occupation, and industry.

METHODS

Data used for this study were obtained from the 2020 National Health Interview Survey (NHIS). The NHIS is conducted annually with the goal of generating representative health data about the United States. Survey data are collected by conducting interviews with households that are identified through random sampling of geographic clusters. In this analysis, the data from the adult questionnaire were used. For the adult questionnaire, from each sampled household, one adult older than 18 years is selected. Survey responses are weighted with weights that correspond to the number of people that each respondent represents, taking into account nonresponse. The NHIS oversamples Black, Asian, and Hispanic adults to generate precise estimates for these populations.³⁵ Participants were included in this analysis if they reported that they had worked in the last week.

Respondents were considered to have access to paid sick leave if they responded yes to this question regarding their current job: “is paid sick leave available if you need it?” Respondents were categorized into one of six age categories (18–24, 25–34, 35–44, 45–54, 55–64, or 65 years or older). Sex was dichotomized male/female. Based on responses to questions about their race and ethnicity, respondents were categorized as either Hispanic or non-Hispanic White, non-Hispanic Black/African American, or non-Hispanic Asian. Although respondents reporting other race/ethnicities were included in this analysis, results for these groups are not shown because of low sample sizes. Respondents were also categorized according to their highest level of education completed (less than high school; GED, highs school, or some college; associate’s or bachelor’s degree; or graduate or professional school) and their geographical region within the United States (Northeast, South, Midwest, West).

Respondents who reported that they were not “covered by any kind of health insurance or some other kind of health care plan” were categorized as being not covered by health insurance. Respondents who reported that they had received “any public assistance or welfare payments from the state or local welfare office” were categorized as receiving public assistance. Based on reported income, respondents were grouped into one of five family income groups: $0–$34,999; $35,000–$49,999; $50,000–$74,999; $75,000–$99,999; or $100,000 or greater. Based on responses to open response questions about their industry and occupation, respondents were grouped into major census industry and occupation groups

Using proc surveyfreq in SAS Version 9.3, we calculated the number and percent of workers as well as the percentage of workers with paid sick leave overall and according to quarter of the year age group, sex, race/ethnicity, educational attainment, region, health insurance coverage, receiving public assistance, income, occupation, and industry. Using Stata, we calculated prevalence ratios (PRs) for the percentage of workers with paid sick leave, taking into account the complex survey design of the NHIS. To explore how differences in employment patterns impacted access to paid sick leave, models that controlled for occupation and industry separately and simultaneously were constructed. Finally, we also controlled for industry, family size, full-time status, job type, sex, age group, region, education, race, and ethnicity.

This analysis was performed on publicly available deidentified data and was therefore considered exempt from institutional review board review.

RESULTS

There were a total of 31,568 respondents to the adult NHIS in 2020. Of these 31,568 respondents, 17,406 reported that they had worked in the past week. Of these 17,406 respondents who were working, 26 were excluded because they were missing data. These exclusions results in a final sample size for this analysis of 17,380. The weighted sample size was 149,109,582.

Overall, 65.6% (95% confidence interval [CI], 64.6%–66.7%) of workers had access to paid sick leave (Table 1). As shown in Figure 1, the percentage of workers reporting access to paid sick leave did not vary substantially during 2020, even in the three last quarters that followed the introduction of emergency paid sick leave for many workers. Access to paid sick leave was lowest among workers ages 18 to 24 (48.7%; 95% CI, 46.9%–50.6%) and 65 years or older (45.3%; 95% CI, 43.8%–46.7%). Compared with those 18 to 24, access to paid sick leave was significantly higher among the 25 to 34, 35 to 44, 45 to 54, and 55 to 64 age groups. Access to paid sick leave was not significantly different according to sex. Access to paid sick leave was highest, among non-Hispanic Asian (71.5%; 95% CI, 67.7%, 75.4%) and non-Hispanic White (66.7%; 95% CI, 65.5%–67.8%) workers. Compared with non-Hispanic White workers, access was significantly lower among Hispanic workers (58.7%; 95% CI, 55.9%–61.4%). Access to paid sick leave was highest among workers with an associate’s or bachelor’s degree (76.7%; 95% CI, 75.6%–77.8%) or a graduate or professional school degree (73.1%; 95% CI, 69.5%–76.6%). Compared with those with a graduate or professional school degree, workers with less than a high school education (43.4%; 95% CI, 39.4%–47.3%) and workers with a GED, high school diploma, or some college (60.1%; 95% CI, 58.5%–61.6%) had significantly lower access to paid sick leave. Workers in western (69.4%; 95% CI, 67.2%–71.7%) and northeast (68.9%; 95% CI, 66.6%–71.1%) states had the highest access to paid sick leave. Compared with workers in western states, workers in southern (62.7%; 95% CI, 60.9%–64.4%) and midwestern states (63.7%; 95% CI, 61.6%–65.8%) had significantly lower access to paid sick leave (Table 1).

TABLE 1 - Percent of Workers With Paid Sick Leave According to Age Group, Gender, Race/Ethnicity, Educational Attainment, Region, Health Insurance Coverage, Receiving Income From Public Assistance, and Family Income Groups, United States, 2020

Variable	n	Weighted n	Weighted No. Workers	Percent of Workers With Paid Sick Leave (95% CI)	Prevalence Ratio (95% CI)	P
Overall	11,885	97,858,543	149,109,582	65.6 (64.6–66.7)
Age groupa
18–24	611	8,966,585	18,396,245 (12.3)	48.7 (46.9–50.6)	1 (ref)
25–34	2,578	24,217,083	33,920,371 (22.7)	71.4 (70.4–72.4)	1.46 (1.34–1.58)	<0.001
35–44	2,876	22,547,924	31,721,809 (21.3)	71.1 (70.1–72.1)	1.45 (1.35–1.57)	<0.001
45–54	2,491	20,416,690	29,778,375 (20.0)	68.6 (67.5–69.6)	1.40 (1.30–1.52)	<0.001
55–64	2,528	17,193,860	25,313,704 (17.0)	67.9 (67.0–68.9)	1.39 (1.29–1.50)	<0.001
≥65	801	4,516,402	9,979,078 (6.7)	45.3 (43.8–46.7)	0.93 (0.85–1.02)	0.121
Sexa
Male	6,000	51,644,151	78,763,321 (52.8)	65.6 (64.2–66.9)	1 (ref)
Female	5,883	46,179,201	70,311,070 (47.2)	65.7 (64.2–67.1)	1.00 (0.97–1.03)	0.849
Race/ethnicitya,b
Non-Hispanic White	8,168	62,429,117	93,635,779 (62.8)	66.7 (65.5–67.8)	1 (ref)
Hispanic	1,507	15,726,294	26,804,820 (18.0)	58.7 (55.9–61.4)	0.88 (0.84–0.93)	<0.001
Non-Hispanic Black/African American	1,125	10,707,608	15,907,867 (10.7)	67.3 (64.0–70.6)	1.00 (0.95–1.06)	0.871
Non-Hispanic Asian	804	6,535,985	9,145,701 (6.1)	71.5 (67.7–75.4)	1.07 (1.01–1.13)	0.017
Educational attainmenta
Graduate or professional school	658	3,980,310	5,448,470 (3.7)	73.1 (69.5–76.6)	1 (ref)
Less than high school	519	6,633,604	15,290,430 (10.3)	43.4 (39.4–47.3)	0.59 (0.53–0.66)	<0.001
GED, highs school, or some college	3,931	39,870,430	66,368,268 (44.5)	60.1 (58.5–61.6)	0.82 (0.78–0.87)	<0.001
Associate’s or bachelor’s degree	6,756	47,066,048	61,367,236 (41.2)	76.7 (75.6–77.8)	1.05 (1.00–1.11)	0.049
Regiona
West	3,174	25,022,200	36,044,338 (24.2)	69.4 (67.2–71.7)	1 (ref)
South	3,749	33,845,817	54,005,218 (36.2)	62.7 (60.9–64.4)	0.90 (0.86–0.94)	<0.001
Midwest	2,723	20,745,074	32,573,163 (21.8)	63.7 (61.6–65.8)	0.92 (0.88–0.96)	<0.001
Northeast	2,239	18,245,452	26,486,863 (17.8)	68.9 (66.6–71.1)	0.99 (0.95–1.03)	0.738
Health insurance coveragea
Covered	11,348	91,690,099	131,155,049 (88.0)	69.9 (68.9–70.9)	1 (ref)
Not covered	522	5,967,751	17,627,081 (11.8)	33.9 (30.8–36.9)	0.48 (0.55–0.53)	<0.001
Receive income from public assistancea
No	11,675	95,671,180	144,683,853 (97.0)	66.1 (65.1–67.2)	1 (ref)
Yes	132	1,382,668	2,719,571 (1.8)	50.8 (43.1–58.6)	0.77 (0.66–0.89)	0.001
Family income group
≥$100,000	5,366	44,822,733	59,812,438 (40.1)	74.9 (73.5–76.4)	1 (ref)	1
$0–$34,999	1,077	8,767,893	21,516,759 (14.4)	40.7 (38.2–43.3)	0.54 (0.51–0.58)	<0.001
$35,000–$49,999	1,227	9,660,145	16,682,057 (11.2)	57.9 (54.8–61.0)	0.77 (0.73–0.81)	<0.001
$50,000–$74,999	2,280	18,341,791	28,349,947 (19.0)	64.7 (62.5–66.9)	0.86 (0.83–0.90)	<0.001
$75,000–$99,999	1,935	16,265,980	22,748,381 (15.3)	71.5 (69.2–73.9)	0.95 (0.92–0.99)	0.012

Paid sick leave access based on responding yes to whether “paid sick leave available if you need it?” at their current job.

Data source: 2020 National Health Interview Survey.

CI, confidence interval.

^aNot showing respondents with missing data.

^bNot showing other race and ethnicity categories because of lower sample sizes.

FIGURE 1: Percent of workers with paid sick leave according to quarter of the year, United States, 2020. Data source: 2020 National Health Interview Survey. Paid sick leave access based on responding yes to whether “paid sick leave available if you need it?” at their current job.

Workers who receive public assistance (50.8%; 95% CI, 43.1%–58.6%) had significantly lower access to paid sick leave compared with workers who did not (69.9%; 95% CI, 68.9%–70.9%) Workers without health insurance coverage (33.9%; 95% CI, 30.8%–36.9%) had significantly lower access to paid sick leave compared with workers with coverage (66.1%; 95% CI, 65.1%–67.2%). Access to paid sick leave was highest among those with a family income of $100,000 or greater (74.9%; 95% CI, 73.5%–76.4%). Compared with those with a family income of $100,000 or greater, all other family income groups had significantly lower access to paid sick leave with the lowest access among those with a family income of less than $35,000 (40.7%; 95% CI, 38.2%–43.3%; Table 1).

Workers in the following occupation groups had access to paid sick leave lower than the average for all workers: personal care and service; farming, fishing, and forestry; construction and extraction; food preparation and serving; building and grounds cleaning and maintenance; arts, design, entertainment, sports and media; transportation and material moving; healthcare support; sales; and production (Fig. 2). With the exception of workers in community and social services; life, physical, and social science; and computer and mathematical occupations, all other occupation groups had access to paid sick leave significantly lower than the occupation group with the highest access—architecture and engineering (88.7%; 95% CI, 85.4%–92.0%) in models that only included occupation. When controlling for family size, full-time status, job type, sex, age group, region, education, race, and ethnicity, PRs were generally attenuated. In this fully adjusted model workers in personal care and service; farming, fishing, and forestry; construction and extraction; food preparation and serving; building and grounds cleaning and maintenance; arts, design, entertainment, sports and media; transportation and material moving; healthcare support; sales; production; installation, maintenance, and repair; office and administrative support; protective service; education, training, and library occupations had PRs indicating significantly lower access than that for architecture and engineering workers (Table 2).

FIGURE 2: Percent of workers with paid sick leave according to occupation group, United States, 2020. Data source: 2020 National Health Interview Survey. Paid sick leave access based on responding yes to whether “paid sick leave available if you need it?” at their current job.

TABLE 2 - Percent of Workers With Paid Sick Leave According to Occupation and Industry Group

Variable	n	Weighted n	Weighted No. Workers	Percent of Workers With Paid Sick Leave (95% CI)	Model 1		Model 2
					Prevalence Ratio (95% CI)	P	Prevalence Ratio (95% CI)	P
Overall	11,885	97,858,543	149,109,582	65.6 (64.6–66.7)
Occupation groupa,b
Architecture and engineering	380	2,915,859	3,287,658 (2.2)	88.7 (85.4–92.0)	1 (ref)		1 (ref)
Personal care and service	109	1,200,340	3,957,973 (2.7)	30.3 (24.5–36.1)	0.34 (0.28–0.41)	<0.001	0.61 (0.51–0.74)	<0.001
Farming, fishing, and forestry	33	323,157	912,457 (0.6)	35.4 (24.4–46.4)	0.40 (0.29–0.55)	<0.001	0.57 (0.41–0.80)	0.001
Construction and extraction	290	3,212,836	8,418,212 (5.6)	38.2 (34.1–42.3)	0.43 (0.38–0.48)	<0.001	0.57 (0.52–0.63)	<0.001
Food preparation and serving related	243	2,628,244	6,371,151 (4.3)	41.3 (36.1–46.4)	0.47 (0.41–0.53)	<0.001	0.66 (0.58–0.74)	<0.001
Building and grounds cleaning and maintenance	258	2,842,823	6,272,886 (4.2)	45.3 (39.9–50.7)	0.51 (0.45–0.58)	<0.001	0.76 (0.68–0.84)	<0.001
Arts, design, entertainment, sports and media	195	1,303,001	2,787,262 (1.9)	46.7 (40.7–52.8)	0.53 (0.46–0.60)	<0.001	0.82 (0.75–0.91)	<0.001
Transportation and material moving	607	6,386,696	11,658,975 (7.8)	54.8 (50.7–58.9)	0.62 (0.57–0.67)	<0.001	0.76 (0.70–0.82)	<0.001
Healthcare support	315	3,097,951	5,588,732 (3.7)	55.4 (49.8–61.1)	0.63 (0.56–69.6)	<0.001	0.79 (0.72–0.88)	<0.001
Sales	869	7,713,507	12,651,045 (8.5)	61.0 (57.8–64.2)	0.69 (0.64–0.73)	<0.001	0.91 (0.86–0.96)	0.001
Production	502	4,955,198	7,688,910 (5.2)	64.4 (60.0–68.9)	0.73 (0.67–78.7)	<0.001	0.82 (0.76–0.89)	<0.001
Installation, maintenance, and repair	336	3,281,186	4,977,366 (3.3)	65.9 (60.5–71.3)	0.74 (0.68–0.81)	<0.001	0.87 (0.81–0.94)	0.001
Office and administrative support	1,298	10,957,482	15,025,930 (10.1)	72.9 (70.2–75.6)	0.82 (0.78–0.87)	<0.001	0.92 (0.87–0.96)	0.001
Management	1,614	11,927,274	15,904,574 (10.7)	75.0 (72.6–77.4)	0.85 (0.80–0.89)	<0.001	0.98 (0.94–1.02)	0.393
Healthcare practitioners and technical	935	6,763,190	8,694,748 (5.8)	77.8 (74.7–80.9)	0.88 (0.83–0.93)	<0.001	0.96 (0.92–1.01)	0.161
Legal	187	1,175,587	1,505,119 (1.0)	78.1 (72.3–83.9)	0.88 (0.81–0.96)	0.004	1.04 (0.97–1.13)	0.276
Protective service	265	2,433,764	3,064,125 (2.1)	79.4 (74.4–84.5)	0.90 (0.83–0.96)	0.003	0.85 (0.79–0.91)	<0.001
Education, training, and library	974	6,941,546	8,586,928 (5.8)	80.8 (78.1–83.6)	0.91 (0.87–0.96)	<0.001	0.91 (0.87–0.96)	<0.001
Business and financial operations	1,022	7,278,529	8,891,682 (6.0)	81.9 (79.1–84.6)	0.92 (0.88–0.97)	0.002	0.99 (0.94–1.03)	0.586
Community and social services	311	2,049,253	2,474,576 (1.7)	82.8 (77.6–88.0)	0.93 (0.87–1.00)	0.065	0.96 (0.90–1.02)	0.194
Life, physical, and social science	207	1,403,950	1,692,553 (1.1)	82.9 (77.5–88.4)	0.94 (0.87–1.01)	0.086	0.94 (0.88–1.01)	0.091
Computer and mathematical	721	5,336,844	6,091,052 (4.1)	87.6 (84.9–90.4)	0.99 (0.94–1.04)	0.613	1.00 (0.96–1.04)	0.980
Industry groupa,c
Public administration	923	6,480,067	7,139,891 (4.8)	90.8 (88.6–92.9)	1 (ref)		1 (ref)
Agriculture, forestry, fishing, and hunting	68	569,763	1,844,830 (1.2)	30.9 (23.4–38.4)	0.34 (0.27–0.44)	<0.001	0.70 (0.54–0.89)	0.004
Construction	494	5,100,863	11,919,033 (8.0)	42.8 (39.2–46.3)	0.47 (0.43–0.51)	<0.001	0.74 (0.68–0.80)	<0.0001
Accommodation and food services	315	3,721,296	8,667,871 (5.8)	42.9 (38.5–47.4)	0.47 (0.42–0.53)	<0.001	0.77 (0.69–0.85)	<0.001
Arts, entertainment, and recreation	150	1,159,070	2,695,865 (1.8)	43.0 (36.4–49.6)	0.47 (0.40–0.55)	<0.001	0.78 (0.69–0.89)	<0.001
Other services (except public administration)	440	3,845,566	8,542,629 (5.7)	45.0 (40.0–49.2)	0.50 (0.45–0.55)	<0.001	0.91 (0.84–0.98)	0.020
Administrative and support and waste management and remediation services	299	2,950,044	6,365,098 (4.3)	46.3 (41.4–51.3)	0.51 (0.46–0.57)	<0.001	0.80 (0.72–0.88)	<0.001
Real estate and rental and leasing	157	1,316,443	2,711,985 (1.8)	48.5 (42.0–55.0)	0.53 (0.47–0.61)	<0.001	0.89 (0.79–0.99)	0.039
Transportation and warehousing	445	4,433,777	7,369,780 (4.9)	60.2 (55.3–65.0)	0.66 (0.61–0.72)	<0.001	0.90 (0.83–0.97)	0.005
Retail trade	946	8,886,472	14,065,437 (9.4)	63.2 (60.0–66.4)	0.70 (0.66–0.74)	<0.001	1.04 (0.97–1.11)	0.240
Health care and social assistance	1,844	14,621,562	20,473,774 (13.7)	71.4 (69.0–73.9)	0.79 (0.75–0.82)	<0.001	1.05 (1.00–1.10)	0.069
Manufacturing	1,220	10,370,890	14,037,478 (9.4)	73.9 (70.9–76.8)	0.81 (0.78–0.85)	<0.001	1.02 (0.97–1.08)	0.482
Professional, scientific, and technical services	1,236	8,874,719	12,004,249 (8.1)	73.9 (71.3–76.6)	0.81 (0.78–0.85)	<0.001	1.08 (1.03–1.14)	0.002
Mining	55	392,949	506,349 (0.3)	77.6 (64.8–90.4)	0.86 (0.73–1.01)	0.063	1.04 (0.87–1.23)	0.698
Information	298	2,310,820	2,927,252 (2.0)	78.9 (74.0–83.9)	0.87 (0.81–0.93)	<0.001	1.10 (1.03–1.19)	0.006
Education services	1,493	10,733,490	12,973,954 (8.7)	82.7 (80.5–85.0)	0.91 (0.88–0.94)	<0.001	1.05 (1.02–1.09)	0.001
Wholesale trade	338	3,049,353	3,660,056 (2.5)	83.3 (78.8–87.9)	0.92 (0.86–0.98)	0.006	1.17 (1.09–1.26)	<0.001
Finance and insurance	781	5,862,040	6,969,599 (4.7)	84.1 (81.5–86.8)	0.92 (0.89–0.96)	<0.001	1.12 (1.06–1.18)	<0.001
Management of companies and enterprises	18	120,633	138,879 (0.1)	86.9 (74.2–99.5)	0.96 (0.83–1.11)	0.560	1.09 (0.93–1.27)	0.279
Utilities	150	1,287,867	1,419,226 (1.0)	90.7 (85.6–95.9)	1.00 (0.94–1.07)	0.996	1.12 (1.04–1.20)	0.002

Model 1—occupation or industry only.

Model 2—occupation or industry controlling for family size, full-time status, job type, sex, age group, region, education, race, and ethnicity.

Data source: 2020 National Health Interview Survey.

CI, confidence interval.

^aNot showing respondents with missing data.

^bNot showing workers in military occupations due to low sample size.

^cNot showing workers in the armed forces due to low sample size.

Workers in the following industry groups had access to paid sick leave lower than the average for all workers: agriculture, forestry, fishing, and hunting; construction; accommodation and food services; arts, entertainment, and recreation; other services (except public administration); administrative and support and waste management and remediation services; real estate and rental and leasing; transportation and warehousing; and retail trade (Fig. 3). With the exception of workers in mining, management of companies and enterprises, and utilities, all other industry groups had access to paid sick leave significantly lower than the industry group with the highest access—public administration (90.8%; 95% CI, 88.6%–92.9%). When controlling for family size, full-time status, job type, sex, age group, region, education, race, and ethnicity, RRs were generally attenuated. In this fully adjusted model workers in the agriculture, forestry, fishing, and hunting; construction; accommodation and food services; arts, entertainment, and recreation; other services; administrative and support and waste management and remediation services; real estate and rental and leasing; and transportation and warehousing industries had PRs indicating significantly lower access than that for public administration workers. In this model, workers in professional, scientific, and technical services; information; education; services; wholesale trade; finance and insurance; and utilities had PRs indicating rates significantly higher access than that for public administration workers (Table 2).

FIGURE 3: Percent of workers with paid sick leave according to industry group, United States, 2020. Data source: 2020 National Health Interview Survey. Paid sick leave access based on responding yes to whether “paid sick leave available if you need it?” at their current job.

Controlling for industry and occupation did not substantially impact differences in access to paid sick leave according to age, sex, or region. Controlling for industry and occupation attenuated the PR for Hispanic workers, while controlling for both industry and occupation resulted in the PR from non-Hispanic White workers no longer being statistically significant. Controlling for industry and occupation reduced the PR for workers with less than a high school education compared with workers with a graduate or professional degree. However, PR for workers with a GED, highs school diploma, or some college differences were no longer statistically significant. In the model that adjusted for both industry and occupation, the PR for workers with an associate’s or bachelor’s degree was significantly elevated compared with workers with a graduate or professional degree. Controlling for industry and occupation reduced, PRs according to health insurance coverage, receiving public assistance, and family income. A fully adjusted model that also controlled for family size, full-time status, job type, sex, age group, region, education, race, and ethnicity had the effect of further attenuating these PRs but did not result in substantially different patterns compared with the model that controlled for only industry and occupation (Table 3).

TABLE 3 - Prevalence Ratios for Access to Paid Sick Leave According to Age Group, Sex, Race/Ethnicity, Educational Attainment, Region, Health Insurance Coverage, Receiving Income From Public Assistance, and Family Income Group Controlling for Industry and Occupation, United States, 2020

Variable	Model 1		Model 2		Model 3		Model 4		Model 5
	Prevalence Ratio (95% CI)	P	Prevalence Ratio (95% CI)	P	Prevalence Ratio (95% CI)	P	Prevalence Ratio (95% CI)	P	Prevalence Ratio (95% CI)	P
Age groupa
18–24	1 (ref)		1 (ref)		1 (ref)		1 (ref)		1 (ref)
25–34	1.46 (1.34–1.58)	<0.001	1.32 (1.22–1.42)	<0.001	1.35 (1.25–1.46)	<0.001	1.29 (1.19–1.39)	<0.001	1.16 (1.08–1.24)	<0.001
35–44	1.45 (1.35–1.57)	<0.001	1.32 (1.23–1.42)	<0.001	1.34 (1.25–1.45)	<0.001	1.27 (1.18–1.37)	<0.001	1.20 (1.12–1.28)	<0.001
45–54	1.40 (1.30–1.52)	<0.001	1.28 (1.19–1.39)	<0.001	1.29 (1.20–1.40)	<0.001	1.24 (1.14–1.33)	<0.001	1.16 (1.09–1.25)	<0.001
55–64	1.39 (1.29–1.50)	<0.001	1.26 (1.17–1.36)	<0.001	1.28 (1.19–1.38)	<0.001	1.22 (1.13–1.31)	<0.001	1.18 (1.10–1.26)	<0.001
≥65	0.93 (0.85–1.02)	0.121	0.85 (0.77–0.93)	<0.001	0.89 (0.81–0.97)	0.010	0.85 (0.77–0.93)	<0.001	1.02 (0.94–1.11)	0.623
Sexa
Male	1 (ref)		1 (ref)		1 (ref)		1 (ref)		1 (ref)
Female	1.00 (0.97–1.03)	0.849	0.96 (0.93–0.99)	0.007	0.94 (0.92–0.97)	<0.001	0.95 (0.92–0.98)	0.001	0.97 (0.95–1.00)	0.043
Race/ethnicitya,b
Non-Hispanic White	1 (ref)		1 (ref)		1 (ref)		1 (ref)		1 (ref)
Hispanic	0.88 (0.84–0.93)	<0.001	1.00 (0.95–1.05)	0.950	0.96 (0.92–1.02)	0.193	1.02 (0.98–1.07)	0.360	1.00 (0.96–1.04)	0.929
Non-Hispanic Black/African American	1.00 (0.95–1.06)	0.871	1.04 (0.99–1.09)	0.108	1.01 (0.96–1.06)	0.806	1.04 (0.99–1.09)	0.127	1.02 (0.97–1.07)	0.431
Non-Hispanic Asian	1.07 (1.01–1.13)	0.017	1.03 (0.97–1.09)	0.324	1.07 (1.01–1.12)	0.021	1.04 (0.99–1.10)	0.152	0.99 (0.95–1.04)	0.806
Educational attainmenta
Graduate or professional school	1 (ref)		1 (ref)		1 (ref)		1 (ref)		1 (ref)
Less than high school	0.59 (0.53–0.66)	<0.001	0.80 (0.71–0.89)	<0.001	0.73 (0.66–0.80)	<0.001	0.84 (0.75–0.93)	0.001	0.84 (0.76–0.92)	<0.001
GED, highs school, or some college	0.82 (0.78–0.87)	<0.001	1.00 (0.94–1.06)	0.919	0.94 (0.89–0.99)	0.015	1.03 (0.97–1.09)	0.396	1.02 (0.96–1.07)	0.556
Associate’s or bachelor’s degree	1.05 (1.00–1.11)	0.049	1.11 (1.05–1.18)	<0.001	1.08 (1.03–1.14)	0.001	1.11 (1.06–1.17)	<0.001	1.06 (1.01–1.11)	0.013
Regiona
West	1 (ref)		1 (ref)		1 (ref)		1 (ref)		1 (ref)
South	0.90 (0.86–0.94)	<0.001	0.90 (0.93–1.01)	<0.001	0.90 (0.91–1.00)	<0.001	0.90 (0.86–0.93)	<0.001	0.88 (0.85–0.91)	<0.001
Midwest	0.92 (0.88–0.96)	<0.001	0.90 (0.86–0.94)	<0.001	0.90 (0.86–0.94)	<0.001	0.90 (0.86–0.94)	<0.001	0.89 (0.85–0.92)	<0.001
Northeast	0.99 (0.95–1.03)	0.738	0.97 (0.93–1.01)	0.150	0.95 (0.91–1.00)	0.034	0.96 (0.92–1.00)	0.044	0.95 (0.92–0.99)	0.009
Health insurance coveragea
Covered	1 (ref)		1 (ref)		1 (ref)		1 (ref)		1 (ref)
Not covered	0.48 (0.55–0.53)	<0.001	0.56 (0.52–0.61)	<0.001	0.57 (0.52–0.62)	<0.001	0.60 (0.55–0.65)	<0.001	0.66 (0.61–0.72)	<0.001
Receive income from public assistancea
No	1 (ref)		1 (ref)		1 (ref)		1 (ref)		1 (ref)
Yes	0.77 (0.66–0.89)	0.001	0.86 (0.75–0.99)	0.041	0.81 (0.70–0.94)_	0.005	0.87 (0.75–1.00)	0.052	0.88 (0.76–1.01)	0.074
Family income group
≥$100,000	1 (ref)		1 (ref)		1 (ref)		1 (ref)		1 (ref)
$0–$34,999	0.54 (0.51–0.58)	<0.001	0.64 (0.60–0.68)	<0.001	0.61 (0.57–0.65)	<0.001	0.66 (0.62–0.71)	<0.001	0.72 (0.68–0.77)	<0.001
$35,000–$49,999	0.77 (0.73–0.81)	<0.001	0.87 (0.82–0.92)	<0.001	0.84 (0.80–0.89)	<0.001	0.90 (0.85–0.95)	<0.001	0.90 (0.85–0.94)	<0.0010
$50,000–$74,999	0.86 (0.83–0.90)	<0.001	0.92 (0.89–0.96)	<0.001	0.91 (0.87–0.95)	<0.001	0.94 (0.90–0.98)	0.002	0.92 (0.89–0.96)	<0.001
$75,000–$99,999	0.95 (0.92–0.99)	0.012	1.00 (0.96–1.03)	0.959	0.99 (0.95–1.02)	0.478	1.01 (0.98–1.04)	0.586	0.99 (0.95–1.02)	0.373

Paid sick leave access based on responding yes to whether “paid sick leave available if you need it?” at their current job.

Data source: 2020 National Health Interview Survey.

Model 1—univariable.

Model 2—controlling for occupation.

Model 3—controlling for industry.

Model 4—controlling for occupation and industry.

Model 5—controlling for occupation, industry, industry, family size, full-time status, job type, sex, age group, region, education, race, and ethnicity.

CI, confidence interval.

^aNot showing respondents with missing data.

^bNot showing other races/ethnicities due to low sample size.

DISCUSSION

This study provides an estimate of overall access to paid sick leave among US workers during the first year of the COVID-19 pandemic. The study estimates 65.6% of workers had access to paid sick leave. This estimate is similar to a previous study that used NHIS data from 2018 to estimate access to paid sick leave¹⁷ and slightly higher than one, which used data from the 2011 American Time Use Survey.¹⁹ However, the estimate in this study is lower that the estimate from one study using data collected in 2020, which estimated that 75% of workers had access to paid sick leave.³⁶ Substantial increases in the percentage of workers reporting access to paid sick leave did not occur in the quarters following the provision of emergency paid sick leave for many workers.

This study showed that there were substantial disparities in access to paid sick leave during the COVID-19 pandemic. Disparities in access to paid sick leave have important public health implications with respect to infectious disease, because not having access to paid sick leave within a workplace may be a risk factor for the spread of infectious disease within that workplace.³⁷ This beneficial impact of paid sick leave is supported by studies that have examined deaths and cases of COVID-19 by industry and occupation. In one study that measured COVID-19 mortality rates by industry and occupation, many of the same essential industries found to have elevated mortality rates for COVID-19 in that study also have low rates of access to paid sick leave in this study.²⁷ Many of the occupation groups identified as having a low availability of paid sick leave in this study also were found to have high mortality rates from COVID-19 in a study conducted using data from Massachusetts.²⁵ In addition, many of the industry and occupation groups identified as having a low availability of paid sick leave in this study also had high rates of COVID-19 infections in a study conducted in Wisconsin.³⁸ In addition, the lower access to paid sick leave among Hispanic workers and workers with lower levels of education and family income may have contributed to the documented higher risk of COVID-19 among people in these groups.^21–24,28 This study also found that workers who were 65 years or older were the least likely to have access to paid sick leave, which is consistent with a previous study.¹⁸ This lower access to paid sick leave is concerning because the much higher risk of severe COVID-19 among older people.

Furthermore, not having access to paid sick leave can compound other vulnerabilities among workers. In this study, workers who were receiving public assistance were less likely to have access paid sick leave than other workers. Workers with lower family incomes and receiving public assistance will be more financially vulnerable if they lose pay from work and will therefore be more incentivized to work while sick. In addition, workers who were not covered by health insurance were less likely to have paid sick leave compared with other workers. If these workers become sick with COVID-19 or other diseases, they will face an additional economic burden both because they cannot take time off from work and receive pay and because they may face high medical costs for any treatment that they receive.

When controlling for industry and occupation, there is a substantial reduction in racial/ethnic, educational, and socioeconomic differences in the availability of paid sick leave. This finding suggests that differences in access to paid sick leave between industries and occupations are an important determinant of access. This finding is consistent with research showing access to paid sick leave to differ across occupational groups.³⁹

These findings have some limitations. Because of the economic effects of the pandemic, some workers may not have been employed at the time of the survey, which may have impacted how comparable these findings are to other years. In addition, some workers may have reported having access to paid sick leave because of the emergency paid sick leave provisioned during the pandemic, which means that the estimates from this study may be overestimates of access to paid sick leave in other years. However, previous research suggests that many workers were unaware that they had access to paid sick leave in 2020 because of the Families First Coronavirus Response Act.³⁶ This finding is supported by the results from this study, which showed that the proportion of workers reporting access to paid sick leave did not increase substantially in the quarters after the law was passed. In addition, we only examine broad occupation and industry groupings in this analysis. Detailed occupations and industries may have different access to paid sick leave.

There were wide disparities in access to paid sick leave during the first year of the COVID-19 pandemic. These disparities may be associated with racial/ethnic and socioeconomic disparities in the risk for COVID-19. In addition, these disparities may have contributed to further economic hardship among economically vulnerable populations. The introduction of mandatory paid sick leave may serve to both protect workers from the spread of infectious diseases and from economic hardships associated with taking time off from work while sick.