Epic Research Analysis Links Sports Betting Legalization to Shifts in Gambling Disorder Diagnosis Rates

Epic Research conducted a dual-team study that examined health records covering more than 197 million U.S. adults, and the resulting figures track changes in quarterly diagnosed gambling disorder rates between the first quarter of 2018 and the first quarter of 2026. States that had legalized sports betting recorded a 61 percent increase in those rates, moving from 3.0 to 4.8 diagnoses per 100,000 patients, while states that maintained prohibitions saw a 29 percent decline over the identical interval. The research team drew its sample from a broad cross-section of medical claims and electronic health records, which allowed analysts to compare outcomes in jurisdictions that introduced legal sports betting markets against those that did not. Observers note that the data collection period spans the rollout of regulated sports wagering across numerous states, beginning shortly after the 2018 Supreme Court decision that cleared the way for expanded legalization.

Scope of the Data Collection

Researchers aggregated quarterly diagnosis counts from insurance claims and hospital records that together represent a substantial majority of the adult population. This approach produced a consistent metric expressed as diagnoses per 100,000 patients, which enabled direct comparisons across state lines and over time. The study period captured both the pre-legalization baseline in 2018 and the post-legalization environment that extended through early 2026, giving analysts a clear window into longitudinal patterns.

Key Rate Changes Observed

In states where sports betting became legal, the quarterly rate climbed steadily after legalization measures took effect, reaching 4.8 per 100,000 by the first quarter of 2026. States without legal sports betting markets experienced the opposite movement, with rates dropping from their 2018 levels to a point 29 percent lower by the same endpoint. The divergence appears consistently across the full eight-year span, and the pattern holds when the data are segmented by calendar quarter.

Demographic Patterns Across Age and Sex

The increase in legalized states occurred among both male and female patients and across every adult age bracket examined. Adults aged 18 to 29 accounted for the largest proportional rise within that group, although absolute numbers grew in older cohorts as well. Analysts tracked these trends by extracting age and sex fields from the same claims database used for the overall rate calculations, which preserved uniformity in measurement across demographic slices.

Timing Relative to Legalization Milestones

Many states completed the transition to legal sports betting between late 2018 and 2022, and the quarterly data show the upward trajectory in diagnosis rates aligning with those regulatory changes. The study design did not isolate individual state rollouts but instead grouped jurisdictions according to whether sports betting had been legalized at any point during the observation window. This grouping method produced the aggregate 61 percent rise reported for the legalized cohort.

Consistency of Measurement Methods

Epic Research applied identical diagnostic coding criteria throughout the study period, relying on standardized medical codes for gambling disorder. Because the same codes were used in both legalized and non-legalized states, the contrasting directions of change cannot be attributed to differences in how clinicians recorded the condition. The dual-team structure further incorporated independent validation steps that cross-checked a subset of records to confirm coding accuracy.

Context Within Broader Health Data Systems

The 197 million adults represented in the dataset come from multiple payer types, including commercial insurance, Medicare Advantage, and Medicaid managed care plans. This mix mirrors the overall insured adult population and reduces the chance that shifts in insurance coverage alone drove the observed rate changes. Quarterly granularity allowed the research teams to align diagnosis counts with specific calendar periods rather than relying on annual aggregates that might obscure shorter-term movements.

Conclusion

The Epic Research findings provide a direct comparison of gambling disorder diagnosis rates in states that introduced legal sports betting versus those that did not, based on records spanning Q1 2018 through Q1 2026. The 61 percent increase in the legalized group and the 29 percent decrease in the non-legalized group appear across age and sex categories, with the steepest proportional change recorded among adults aged 18 to 29. Full details appear in the original report published by Epic Research.