Study Shows Gambling Disorder Diagnoses Climb in Legal Sports Betting States

Electronic health records covering more than 197 million U.S. adults reveal a clear pattern in how gambling disorder diagnoses shifted after sports betting expanded, according to a recent commentary in Sports Business Journal that highlights findings from a large-scale study. The analysis tracks data from the first quarter of 2018 through the first quarter of 2026 and focuses on the 39 states that legalized sports betting during that period, where rates moved from 3.0 to 4.8 per 100,000 patients, an increase of roughly 61 percent. In contrast, the 11 states that kept sports betting illegal saw rates drop about 29 percent, from 3.1 to 2.2 per 100,000 patients, over the same span.

Researchers pulled the figures from a broad set of electronic records that allowed them to compare trends before and after legalization took hold in different jurisdictions. The biggest proportional jump appeared among adults aged 18 to 29, where rates more than doubled, and the increase fell disproportionately on males in that age group. Absolute numbers stayed low across the board, yet the commentary points to expanded access and heavier advertising as factors tied to the rise in states that opened legal markets.

Scope of the Data and Timeline

The study period stretches from early 2018, when most states still prohibited sports betting, through early 2026, when legalization had spread widely. Observers note that the rollout happened at different times in different states, which gave researchers a natural way to measure changes against states that stayed closed. Data collection relied on consistent diagnostic codes in electronic health records, allowing direct comparison of incidence rates before and after new laws took effect. Those who've reviewed the methodology emphasize that the sample size of 197 million adults provides a national view that captures both urban and rural populations across participating health systems.

Age and Gender Patterns in the Results

Young adults drove much of the overall increase. In the 18-to-29 age bracket, diagnosis rates climbed sharply in legalized states, while older groups showed smaller shifts. The data also indicate that males accounted for the majority of the added cases within that younger cohort. Experts who examined the breakdowns point out that this demographic pattern aligns with broader participation trends in sports betting apps and marketing campaigns that target college-age and early-career audiences. Figures from the study further show that the proportional growth in this group exceeded the national average, reaching more than double the starting rate in states with legal markets.

States without legalization recorded declines across most age groups, including the 18-to-29 segment. This contrast appears consistently in the records, giving analysts a side-by-side view of how policy differences correspond to diagnostic trends. The commentary in Sports Business Journal notes that these state-level variations emerged even as national advertising for betting services increased, suggesting localized access plays a measurable role.

Context on Absolute Rates and Contributing Factors

Although the proportional changes stand out, the raw rates remain modest. The study reports that even after the rise, diagnoses reached only 4.8 per 100,000 patients in states with legal sports betting, compared with 2.2 per 100,000 in states that maintained bans. Researchers attribute part of the difference to greater availability of betting platforms and the volume of advertising that followed legalization. The commentary highlights that these environmental changes coincided with the observed uptick, while states that kept restrictions in place experienced the opposite movement in the same records.

Additional details from the analysis cover the eight-year window and the staggered timing of state laws. Because some states legalized early and others later, the data allow for before-and-after comparisons within the same population pools. People who track public health metrics note that the study design helps isolate the effect of policy changes from other national trends that might affect gambling behavior.

Conclusion

The commentary published in Sports Business Journal draws directly from the large-scale review of electronic health records to present these state-by-state differences. Data from the first quarter of 2018 to the first quarter of 2026 show higher diagnosis rates in jurisdictions that legalized sports betting and lower rates in those that did not, with the sharpest movement concentrated among younger males. The findings also appear in related reporting from EPIC Research, which supplies additional context on the same dataset. Observers continue to monitor how these patterns evolve as more states refine their regulatory approaches into the second half of 2026.