Gambling Disorder Diagnoses Climb Sharply After Sports Betting Legalization

Electronic health records across multiple U.S. states reveal a clear uptick in gambling disorder diagnoses that coincides with the spread of legal sports betting, and researchers tracking those records point directly to the 2018 Supreme Court ruling that opened the door for states to authorize such wagering. The analysis examined diagnosis rates from 2018 onward and found increases exceeding 60 percent in jurisdictions where sports betting became legal, while rates stayed comparatively flat in states that maintained prohibitions. Data collected through large-scale health networks showed the per capita rate moving from 3.0 diagnoses per 100,000 people to 4.8 per 100,000 during the same period, with the steepest climbs appearing among men aged 18 to 34.

Study Methodology and Scope

Investigators pulled de-identified records from a broad sample of U.S. electronic health systems and applied consistent diagnostic codes to measure changes over time, allowing them to isolate trends in states that passed sports betting legislation versus those that did not. The approach relied on longitudinal data rather than self-reported surveys, which reduced recall bias and captured cases that reached clinical attention. Because the 2018 Supreme Court decision removed the federal barrier that had blocked most states from offering sports books, the timeline provided a natural experiment for comparing pre- and post-legalization periods across different regulatory environments.

States that moved quickly to license operators saw the earliest measurable shifts in diagnosis patterns, whereas states that delayed or declined to legalize showed smaller or negligible changes during the same years. The study authors noted that the largest relative increases clustered in demographic groups most likely to engage with mobile betting apps, particularly younger adult males who gained easy access through smartphones once operators launched in their states.

Demographic Patterns in the Data

Breakdowns by age and sex highlighted that young men accounted for the majority of the added diagnoses, although smaller increases appeared across other groups as well. Observers tracking the numbers emphasize that the rise tracks the availability of legal markets rather than any sudden change in underlying mental health screening practices. Electronic records captured both new diagnoses and repeat visits, giving a fuller picture of how often clinicians documented gambling-related problems after sports betting expanded.

Further segmentation showed urban areas with multiple licensed sportsbooks experienced faster growth than rural regions where fewer betting options existed, yet the overall state-level pattern remained consistent once legalization took effect. Researchers cross-checked their findings against population estimates to convert raw counts into standardized rates per 100,000 residents, which allowed direct comparison across states of different sizes.

Connection to 2018 Supreme Court Ruling

The Supreme Court’s 2018 decision struck down the Professional and Amateur Sports Protection Act, freeing states to regulate sports wagering according to their own policies. Within months several states passed enabling legislation, and by 2023 dozens had active markets; the health-record analysis aligns the timing of those rollouts with the observed acceleration in gambling disorder diagnoses. Because the study focused exclusively on states that legalized, it avoided conflating national trends with localized regulatory changes and instead isolated the effect of expanded legal access.

Public health agencies in states that adopted sports betting have since begun reviewing their own data sets to see whether similar patterns emerge in hospital admissions or helpline calls, though the electronic health record study remains one of the first to quantify the shift at a national scale. The EPIC Research analysis supplies the central figures cited in recent coverage and continues to serve as a reference point for ongoing monitoring efforts.

Current Context in Mid-2026

As of July 2026 most states that chose to legalize have operated regulated markets for several years, giving analysts additional data points to track whether the upward trajectory in diagnoses continues, plateaus, or begins to moderate. Some jurisdictions have introduced responsible-gambling tools such as deposit limits and self-exclusion lists, yet the health-record study predates those interventions and therefore reflects conditions before such measures became widespread. Continued surveillance of electronic records will reveal whether newer safeguards alter the earlier pattern.

Conclusion

The documented rise in gambling disorder diagnoses from 3.0 to 4.8 per 100,000 people in states that legalized sports betting after 2018 offers a measurable signal tied to regulatory change. Young men showed the largest increases, consistent with their higher participation rates in mobile sports wagering. The findings rest on analysis of electronic health records that capture clinical diagnoses rather than anecdotal reports, and they align temporally with the expansion of legal markets following the Supreme Court ruling. Future updates to the same data sources will clarify whether the trend persists or shifts as additional consumer protections take hold.