Health Records Analysis Tracks Gambling Disorder Trends After Sports Betting Expansion

Researchers at Epic Research examined electronic health records covering more than 197 million U.S. adults from January 2018 through March 2026, and the resulting figures reveal a clear split between states that expanded sports betting access and those that did not. In the 39 states plus the District of Columbia that legalized sports betting after the 2018 Supreme Court decision, the quarterly diagnosis rate climbed from 3.0 to 4.8 cases per 100,000 patients, which amounts to a 61 percent rise, while the 11 states that maintained prohibitions saw their rate drop from 3.1 to 2.2 cases per 100,000, a 29 percent decline. The study period captures the full rollout of retail and online sportsbooks in many jurisdictions, allowing direct comparison of diagnosis trends before and after legalization took effect.

Study Scope and Data Sources

The analysis drew on de-identified records from a large network of health systems, and the sample size provided enough statistical power to detect differences across demographic groups and geographic regions. Observers note that overall diagnosis rates stayed low throughout the eight-year window, yet the divergence between the two groups of states grew steadily after 2018, and the pattern held even when researchers adjusted for population density and baseline healthcare utilization. Because the data extend through March 2026, the trends reflect the cumulative impact of expanded access, including mobile betting apps that became widely available in legal markets during 2022 and 2023.

State-Level Comparisons

States that introduced legal sports betting experienced consistent quarter-over-quarter increases in diagnosed cases once operators began accepting wagers, whereas non-legal states showed gradual declines or stable numbers. The contrast appears tied to greater availability of both in-person and online platforms, which removed previous barriers that had kept participation lower. Data from the Epic Research report indicate that the gap between the two sets of states widened most noticeably after 2021, when several large markets launched full-scale online offerings.

Demographic Patterns

Adults aged 18 to 29 accounted for the steepest proportional rise, with rates more than doubling in states that legalized betting, while older age bands recorded smaller though still positive increases. Male patients showed higher absolute rates than female patients across every state group, yet the relative growth among young adults outpaced all other categories regardless of gender. Researchers tracked these shifts by linking diagnosis codes to patient zip codes, which allowed them to map changes directly to state policy environments without relying on self-reported survey data.

Timing and Policy Context

The 2018 Supreme Court ruling opened the door for states to regulate sports wagering, and by early 2026 most jurisdictions had moved forward with some form of legalization. The health records analysis captures the period immediately before and after these policy shifts, and the resulting numbers align with the staggered adoption timeline across different regions. In states that delayed or declined legalization, diagnosis rates either held steady or continued the modest downward trajectory observed before 2018, suggesting that the absence of expanded access coincided with different utilization patterns.

Conclusion

The Epic Research findings document a measurable association between sports betting legalization and rising gambling disorder diagnoses, particularly among younger adults and in states that permitted both retail and online platforms. Rates remained low in absolute terms, yet the 61 percent increase in legal states compared with the 29 percent decrease in non-legal states underscores a policy-linked divergence that continued through March 2026. As of August 2026, public health officials and state regulators continue to review these figures alongside other indicators when evaluating ongoing oversight of the expanded betting market.