Electronic Health Records Study Tracks Gambling Disorder Trends After Sports Betting Expansion

A fresh review of electronic health records from more than 197 million American adults has documented clear differences in diagnosed gambling disorder rates between states that legalized sports betting and those that did not, with the patterns emerging across the period from the first quarter of 2018 through the first quarter of 2026. Researchers compiled quarterly diagnosis figures and compared outcomes in the two groups of states, producing a side-by-side picture of how rates moved as legalization spread. The analysis found that states permitting sports betting experienced a 61 percent rise in quarterly diagnosis rates, moving from 3.0 to 4.8 cases per 100,000 adults. In contrast, states that kept sports betting illegal recorded a 29 percent decline, dropping from 3.1 to 2.2 cases per 100,000 adults over the same eight-year span. These figures come from a large-scale aggregation of de-identified records that captured both new and ongoing diagnoses at regular intervals.

Age Group Patterns Stand Out

Young adults showed the steepest movement. Among those aged 18 to 29, diagnosis rates more than doubled in states with legalized sports betting, outpacing every other age bracket examined. Older cohorts displayed smaller proportional changes, though increases still appeared in the legalized-state group while remaining flat or lower in states without legalization. The concentration of growth among younger adults aligns with the timing of expanded mobile betting access that began rolling out after the 2018 Supreme Court decision.

Study Design and Data Sources

The project drew on a nationwide sample of electronic health records maintained by multiple health systems and insurers, allowing quarterly snapshots rather than annual aggregates. Analysts tracked diagnosis codes tied to gambling disorder and stratified results by state legalization status at each quarter. Because the dataset spans both pre- and post-legalization periods in many jurisdictions, it offers a built-in comparison that accounts for broader national trends in mental health screening. Data collection ran continuously from Q1 2018 through Q1 2026, capturing the staggered rollout of retail and online sportsbooks across more than two dozen states.

Legalization Timeline Context

By early 2026, more than half of U.S. states had authorized some form of sports betting, creating a natural experiment for the health-record analysis. States that moved earliest, such as New Jersey and Pennsylvania, contributed the longest post-legalization observation windows, while later adopters supplied shorter but still measurable intervals. The study grouped states strictly by whether they had active legal markets during each quarter, rather than by date of first legislation, to reflect actual availability of regulated betting options.

Observers note that diagnosis rates began diverging most noticeably after 2021, when several large states launched online platforms. The quarterly granularity made it possible to align rate changes with the precise calendar quarters in which new betting products became accessible to residents.

Interpretation of Rate Shifts

According to the compiled statistics, the 61 percent increase in legalized states occurred alongside stable or slightly rising overall mental-health visit volumes, suggesting the gambling-disorder trend was not simply an artifact of more people seeking care. In non-legalized states the 29 percent decline took place even as screening rates held steady, pointing to a directional difference tied to state policy status. The data release occurred in June 2026 and has since circulated among public-health researchers tracking behavioral health outcomes connected to expanding gambling access.

Next Steps for Monitoring

Public-health agencies in multiple states have begun reviewing the quarterly diagnosis series to determine whether additional screening protocols or treatment capacity adjustments are warranted. Because the underlying dataset continues to be updated, future quarters can be added to the same analytic framework, allowing ongoing comparison between the two state groupings. The existing eight-year window already supplies one of the largest longitudinal views available on this particular diagnostic category since widespread sports-betting legalization began.

Conclusion

The electronic health records analysis supplies a clear numerical contrast: legalized states recorded rising quarterly gambling-disorder diagnoses while non-legalized states recorded declines, with the sharpest movement concentrated among adults aged 18 to 29. The study covers 197 million adults across the full period from Q1 2018 to Q1 2026 and stands as a primary data point for anyone examining health-system impacts that followed the expansion of regulated sports betting. Further quarters of data will show whether the observed divergence persists or narrows as markets mature.