Language

English

Publication Date

8-1-2026

Journal

Addiction

DOI

10.1111/add.70397

PMID

41872026

PMCID

PMC13357941

PubMedCentral® Posted Date

3-23-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Background and aims: Gambling disorder (GD) has been linked to suicidal ideation and suicide deaths; however, evidence on all-cause and cause-specific mortality-particularly in Asian populations-remains limited. Using a retrospective cohort study based on nationwide matched and sibling cohort, we investigated all-cause and cause-specific mortality risk in patients with GD.

Design, setting and participants: A retrospective cohort study was conducted using 2000-2022 data from Taiwan's National Health Insurance Research Database. A cohort of 961 individuals diagnosed with GD was identified. An age- and sex-matched control cohort (n = 3,844) and an unaffected sibling cohort (n = 675) were constructed. Cumulative survival was illustrated using Kaplan-Meier curves.

Measurements: Cox regression models estimated crude and adjusted hazard ratios (AHR) for all-cause, natural-cause and unnatural-cause (accidents and suicides) mortality risks. Covariates for adjustment included sociodemographic factors, physical and psychiatric comorbidities and familial confounding.

Findings: Over a mean follow-up of 8 years, GD was associated with elevated all-cause mortality risk [AHR 1.20, 95% confidence interval (CI) = 0.90-1.61] driven by statistically significantly elevated risk of unnatural mortality (AHR 6.15, 95% CI = 3.44-10.98) and especially suicide mortality (AHR 10.03, 95% CI = 4.71-21.33). Risk of natural mortality was statistically significantly lower in GD patients (AHR 0.66, 95% CI = 0.45-0.96). Sibling cohort analysis revealed a similar trend (all-cause mortality: AHR 1.70, 95% CI = 0.67-4.28; unnatural cause mortality: AHR 8.65, 95% CI = 1.62-46.22; suicide mortality: AHR 7.24, 95% CI = 0.74-70.59; natural cause mortality: AHR 0.48, 95% CI = 0.13-1.73). Results remained consistent after adjustment for individual psychiatric comorbidities.

Conclusions: Gambling disorder patients in Taiwan appear to have a statistically significantly increased risk of unnatural-cause mortality and especially suicide mortality compared with matched controls. Policies and clinical interventions for treating GD patients should focus on suicide prevention to reduce mortality in this population.

Keywords

Humans, Taiwan, Female, Gambling, Male, Retrospective Studies, Cause of Death, Adult, Middle Aged, Siblings, Suicide, Proportional Hazards Models, Cohort Studies, Kaplan-Meier Estimate, Young Adult

Published Open-Access

yes

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