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Health Problems and Medical Utilization Associated With Gambling Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

From the Department of Psychiatry (B.J.M., R.H.P., N.M.P.), University of Connecticut Health Center, Farmington, Connecticut; the Department of Psychiatry (C.B., D.H.), Columbia University, New York, NY; and the Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research (B.F.G.), National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland.

Address correspondence and reprint requests to Nancy M. Petry, PhD, Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3944. E-mail: petry{at}psychiatry.uchc.edu

Objective: Pathologic gambling is believed to be associated with adverse health consequences, but no prior studies have rigorously evaluated these relationships. We sought to examine medical disorders and health service utilization associated with problem and pathologic gambling.

Method: A total of 43,093 adults aged 18 years and older were evaluated in the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions. Self-reported medical diagnoses and past-year medical services used were assessed.

Results: Pathologic gamblers were more likely than low-risk individuals to have been diagnosed with tachycardia (odds ratio [OR] = 1.77; 95% confidence interval [CI] = 1.05–2.97), angina (OR = 2.35; 95% CI = 1.33–4.15), cirrhosis (OR = 3.90; 95% CI = 1.11–13.72), and other liver disease (OR = 2.98; 95% CI = 1.07–8.26). Gambling severity was also associated with higher rates of medical utilization with pathologic gamblers more likely than low-risk individuals to have been treated in the emergency room in the year before the survey (OR = 1.98; 95% CI = 1.27–3.09). Significant effects of gambling severity remained even after controlling for demographic characteristics (age, gender, ethnicity, marital status, education, income, and region of the country) and behavioral risk factors such as body mass index, alcohol abuse and dependence, nicotine dependence, and mood and anxiety disorders.

Conclusions: A lifetime diagnosis of pathologic gambling is associated with several medical disorders and increased medical utilization, perhaps leading to a burden on healthcare costs in the United States.

Key Words: pathologic gambling • health functioning • medical utilization • epidemiology • psychiatric disorder • mental health

Abbreviations: AUDADIS-IV = Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV; BMI = body mass index; CI = confidence interval; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition; ER = emergency room; NESARC = National Epidemiologic Survey on Alcohol and Related Conditions; NIAAA = National Institute on Alcohol Abuse and Alcoholism; OR = odds ratio; SES = socioeconomic status; SF-12v2 = Short-Form Health Survey, Version 2.