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When Pews Emptied Out in the ’90s, Death Rates Exploded. The Connection To Blue Laws Is Clear. In a Nutshell

People didn’t replace church with other community activities, suggesting religious communities provided unique social benefits

When states repealed Sunday shopping restrictions in the 1980s-90s, church attendance among middle-aged Americans dropped 5-10 percentage points

Death rates from suicide, drug poisoning, and liver disease increased by about 2 per 100,000 people in states that repealed these laws

Religious decline could account for roughly 40% of the mortality increase observed by 1996—before OxyContin was introduced

The decision to let stores open on Sundays may have had real public health consequences. Research reveals that when states repealed laws restricting Sunday commerce in the 1980s and early 1990s, religious attendance dropped and deaths from suicide, drug poisoning, and liver disease climbed. Declining religious participation could account for roughly 40% of the early rise in these deaths among middle-aged Americans, according to researchers.

Scientists from Wellesley College, the University of Notre Dame, and The Ohio State University examined what happened when states abolished blue laws that once prohibited most retail activity on Sundays. Repealing these laws led to a 5- to 10-percentage-point drop in weekly church attendance among middle-aged Americans and an increase of about 2 deaths per 100,000 people.

Economists Anne Case and Angus Deaton brought widespread attention to rising deaths from suicide, drug poisoning, and liver disease. Another team of researchers, David Cutler and Adriana Lleras-Muney, called this rise in mortality “one of the most important economic and demographic issues of our time.” Yet most research has focused on declining job prospects or opioid availability. This analysis points to a different factor that emerged earlier: America’s changing relationship with organized religion.

When Sunday Shopping Became Legal

Blue laws once prohibited most labor and economic activity on Sundays. A 1961 Supreme Court decision opened the door for legal challenges, and states began repealing the laws over the following decades. Minnesota, South Carolina, and Texas all scrapped their blue laws in 1985. North Dakota held out until 1991.

Researchers saw an opportunity in this staggered rollout. If losing blue laws made it easier to skip church and that change genuinely harmed public health, states that repealed earlier should show effects before states that repealed later. The data confirmed this pattern: religious attendance fell among middle-aged residents in states that repealed blue laws, followed by rising death rates from suicide, liver disease, and drug poisoning.

The rollout of OxyContin in 1996 made a bad situation worse. (© JJAVA – stock.adobe.com) A 40% Factor in Rising Deaths

The study, published in The Journal of the European Economic Association, tracked 24 states from 1969 to 2000, using Centers for Disease Control data that captures nearly every death in America. Religious participation came from the General Social Survey, a nationally representative poll that has measured American attitudes since 1973. For middle-aged Americans, repealing blue laws produced a 9-percentage-point drop in weekly church attendance and an 11-percentage-point drop in those reporting strong religious affiliation.

Those changes came with deadly consequences. Blue law repeals increased deaths of despair by roughly 2 per 100,000 people in this age group. Suicide showed the strongest response, jumping by 1.2 deaths per 100,000. Effects on liver disease and drug poisoning were positive but less precisely measured. Other common causes of death like heart disease, diabetes, and most cancers showed no consistent pattern.

The magnitude becomes clearer when scaled to the broader decline in religiosity that swept America in the 1990s. Religious attendance among middle-aged white Americans without a college degree plummeted during this period. Weekly church attendance dropped by 32% from its peak by the end of the decade. The share reporting weak or no religious affiliation surged. Both men and women experienced similar declines, in both rural and urban areas.

Applying the measured effects from blue law repeals to this larger drop in religious participation nationwide produces a sobering calculation. By 1996, when OxyContin was introduced, death rates among white Americans aged 45-64 stood about 17% higher than expected based on 1980s trends. The religious decline during the 1990s could account for roughly 40% of that 17% increase, the researchers estimate.

What Churches Provided That Nothing Else Could Replace

State-level patterns reinforce the connection between religion and mortality. States with higher religious attendance in the late 1980s generally had lower rates of deaths of despair. States that experienced the largest drops in attendance between 1986 and 2000 saw the largest increases in these deaths.

How does losing religious participation lead to more deaths? The research team explored several pathways. After blue law repeals, people in this age group became much more likely to report sometimes drinking too much, an 8.5-percentage-point increase compared to an average of 26% who said they drank excessively. Religious belief itself appeared to matter, with evidence that blue law repeals led to decreased belief in the afterlife.

The study also tested whether people simply replaced church with other forms of community engagement. The evidence suggests they didn’t. The study finds little evidence that middle-aged individuals reduced membership in civic organizations or changed how often they socialized with friends, neighbors, or relatives after blue law repeals. Church membership declined marginally, but other community involvement held steady. Whatever benefits religious communities provided couldn’t easily be replicated elsewhere.

Local parishes and religious communities provided an invaluable support system for countless Americans. When attendance rates dropped, there was a clear impact on public health. (PeopleImages.com – Yuri A/Shutterstock)

This finding helps solve a puzzle that has challenged researchers: why did deaths of despair hit white Americans without college degrees so hard? The answer may lie in who stopped going to church. The decline in religious participation was driven precisely by this demographic. Non-white Americans saw smaller drops in attendance and correspondingly smaller increases in mortality during this period.

America’s context may have amplified the effects. Many European countries experienced gradual, decades-long declines in religious participation. America’s drop came relatively suddenly and concentrated among a specific group. The United States also maintains a comparatively weak social safety net. If religious communities provide mutual support and informal insurance that government programs offer elsewhere, losing that connection could prove especially damaging in the American setting.

The research timeline matters. Blue law repeals occurred in the 1980s and early 1990s, before the current opioid crisis exploded. The study period ends in 2000, years before OxyContin was reformulated in 2010 and fentanyl became widespread. Declining religiosity created vulnerability in American communities. When powerful opioids later flooded those same communities, the effects may have been magnified.

Policies that seem far removed from public health can have life-or-death consequences. Sunday shopping laws were repealed to boost economic activity and personal freedom. Decades later, researchers can trace a thread from those policy changes through declining church attendance to rising mortality.

Paper Summary Limitations

The study faces several limitations inherent in observational research. While blue law repeals offer a useful way to study religiosity changes, they occurred decades before the current crisis and in a different policy environment. The analysis cannot definitively prove that religiosity changes caused mortality changes, only that they are strongly linked. The study period ends in 2000, before many recent developments in the opioid crisis. The General Social Survey has limited sample sizes for some demographic subgroups, making precise estimates difficult. State-level blue law changes may have been influenced by unobserved factors, though the researchers present evidence against this concern. The study cannot fully separate the effects of personal religious belief from participation in religious communities.

Funding and Disclosures

The research received funding from the National Institute on Aging through Grant Number T32-AG000186, the National Science Foundation Graduate Fellowship Program under Grant Number 1122374, and the Church Sexual Abuse Crisis Research Grant Competition. The authors declare that they have no relevant or material interests that relate to the research described in the paper.

Publication Details

The paper “Deaths of Despair and the Decline of American Religion” was authored by Tyler Giles of Wellesley College, Daniel Hungerman of the University of Notre Dame and the National Bureau of Economic Research, and Tamar Oostrom of The Ohio State University and the National Bureau of Economic Research. The working paper was accepted in July 2025 by The Journal of the European Economic Association and published on November 28, 2025. The DOI is 10.1093/jeea/jvaf048.