Gambling harm in Adult Gamblers

Updated: Apr 14

Gambling harm in the population
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Executive Summary

Years of healthy life lost (annually)

  • 1.10 million years of healthy life are lost due to disability (YLD) (0.47m years in low-risk harm gambling + 0.32m years in moderate-risk harm gambling + 0.31m years in problem-gambling harm)

  • 45870 years of healthy life are lost due to mortality (YLL) in 20-50-year-old problem gamblers

  • 1.15 million years of healthy life are lost (DALYs) due to gambling harm in adult gamblers in Great Britain 2020, or 6.9% of all DALYs

We estimate that, on average, two individuals lose their lives to suicide every day. Other significant suicidal-harm amongst 'problem gamblers' in Great Britain (annually):

  • 123, 331 individuals have suicidal ideation

  • 30, 191 individuals have suicidal attempts

Background

  • We present an analysis to quantify the total cost of healthy life (DALYs) by first measuring Years of Life Lost due to mortality (YLL) and Disability (YLD) due to gambling harm in GB gamblers.

  • In 2016, the Institute of Fiscal Studies thinktank found that the public cost of problem gambling was between £260m and £1.2bn a year.

  • An estimate of public costs is limited in scope as it considers costs to the taxpayer without consideration of the costs or the harms incurred on a private-basis

Methods

  • A disability weight is a weight factor that reflects the severity of the disease on a scale from 0 (perfect health) to 1 (equivalent to death)

  • Years Lost due to Disability (YLD) are calculated by multiplying the prevalence and disability weights.

  • Standardized Mortality Ratio (SMR): Observed number of deaths in a study population: Expected number of deaths based on the age- and sex-specific rates in a standard population and the population size of the study population by the same age/sex groups

  • Years lost due to Loss of Life (YLL) is calculated by multiplying the number of deaths in each age range by the differences in years from age- and sex-specific life expectancies.

Results

Prevalence of gambling-harm

According to the last well design gambling prevalence survey in Great Britain (BGPS 2010), the prevalence of low-risk, moderate-risk, and problem gambler harms is estimated at 5.5%, 1.8%, and 1.2%, respectively.


Using a 2020 population estimate of 53.6 million individuals that are 16 and over, we estimate that in this population, there are:

  • 643, 000 suffer problem gambler harm

  • 965, 000 suffer moderate-risk gambling harm

  • 2, 950, 000 suffer low-risk gambling harm

A total of 4.56 million 16+ gamblers are estimated to suffer significant gambling harm in the past 12 months.


Disability Weights

Studies in Australia (2017) and New Zealand (2018) have estimated disability weights for gambling-harm at the three levels of 'Problem Gambling,' 'Moderate Risk Gambling,' and 'Low-Risk Gambling.' Disability Weights for other health states are sourced from the Global Burden of Disease Study 2010.


According to results in Australia (2017), the harm in affected others is similar in severity to harm in gamblers, though slightly higher, at low-risk and moderate-risk levels (DW=.17 versus .13) and moderate (.33 versus .29). At the problem gambler level, disability weights for affected others were estimated significantly lower than those for the gambler (.36 versus .44).


In the New Zealand (2018) study, harm in affected others were grouped with gamblers' harm without stratification.


Unfortunately, a dearth of research in this area leaves us to use a median for each level as an estimate for disability weights in Great Britain in 2020.


Years Lost due to Disability

Years of Life Lost

  • We estimate the number of deaths in problem gamblers using the BGPS 2010 to estimate the age-gender distribution of problem gamblers by PGSI screen with standardised mortality ratios of 4.6* in Men and 10.5* Women.

  • Loss of life in the 20-49-year-old GD population in Great Britain due to gambling harm amounted to 1225 additional deaths (5.3% of the total number of deaths in this age range) and 45, 900 years of life lost.

  • Overall, there are 1517 deaths in this population representing 56, 800 years of life lost.

Disability-Adjusted Life Years

  • 1.10 million years of healthy life lost due to disability (YLD) and 45870 years of healthy life lost due to mortality (YLL)

  • 1.15 million years of healthy life lost (DALYs) due to gambling-harm

Context around DALYs in England 2013

  • Dietary risks: 1.47m (10.8%)

  • Tobacco smoke: 1.46m (10.7%)

  • Gambling-harm in adult gamblers: 0.94m (6.9%)

(Estimated from gambling-harm in Great Britain 2020: 1.15m, England 2013 population: 53.9m, Great Britain 2020 population: 66.1m)

  • Alcohol use: 0.55m (4.0%)

  • Drug use: 0.27m (2.0%)

Limitations

In large part, this harm to health analysis applies statistics from international studies on the GB population.

  • To calculate YLL, a longitudinal study in Sweden that had inclusion criteria of GD diagnosis was used. An inclusion criteria of GD diagnosis limits the representativeness of the GB population as they are largely undiagnosed.

  • To calculate YLD, a disability weight for GB was estimated by taking the median of results from Australia and New Zealand.

Gambling-harm not included in this estimate

  • YLD & YLL in Former Gamblers. The prevalence of lifetime gambling disorder has never been measured in the UK.

  • YLD & YLL in Affected Others

  • YLD & YLL in Under 16 gamblers. Although there is evidence that reflects significant levels of harm in under 16 gamblers, the severity of this has not yet been quantified into disability weights

  • YLL in problem gamblers due to mortality in 16-20 and 50+-year-olds

  • YLL in low-risk and moderate-risk harm gamblers due to mortality

Suicide

Harm data from Adult Psychiatry Morbidity Survey (2007) and prevalence using BGPS 2010

  • One in five problem gamblers had thoughts about suicide in the past year (123, 331 individuals; 6% of individuals with past-year suicidal ideation were problem gamblers)

  • One in twenty problem gamblers had made a suicide attempt in the past year (30, 191 individuals; 10% of individuals with past-year suicidal attempt were problem gamblers)

  • Estimating number of loss of lives from suicide using a number of suicide attempts: 1200 suicides (25 attempts to 1 suicide)

Harm data from a Swedish nationwide register study and prevalence using BGPS 2010

  • Total number of suicides in UK 2018 – 6,507, 20-50-year-old GD (PGSI: 0.7%, 2020 population estimate) population of 307, 000 (254, 000 males + 53, 700 females), Estimated number of suicides using age-gender appropriate suicide mortality rates: 39.6, Estimated number of suicides using gambling-related standardized mortality ratio of 19.3: 763.8, Difference due to GD: 724

  • There are estimated to be two gambling-related suicides per day (764 individuals; 12% of all suicides were in problem gamblers)

  • Extrapolating results from the study on 2,099 individuals with GD diagnosis that spanned 4.7 years, an estimated 383 suicides occur in the overall problem gambler population in Sweden every year (approx. 30% of all suicides in Sweden; Sweden has a PG prevalence of 2.0%, GB: 1.2%)

Other studies on suicide harm amongst problem gamblers

  • A review by Gambling with Lives reported average suicidal ideation (n=13) and attempt rates (n=17) of 42% (two in five) and 20% (two in twenty), respectively. These estimates are in line with other findings. However, heterogeneity analysis is needed due to the differences in study designs, for example, due to different time spans referred to

  • Globally, the highest estimate has been reported in Australian pathological gamblers in treatment, with rates of suicidal ideation and attempt (one or more) in the past 12 months at 81.4% and 30.2%, respectively

  • A retrospective case series in Hong Kong reported that 11.3% of 150 suicides were in pathological gamblers

Conclusion

  • Our analysis found that gambling harm caused the loss of 1.15m DALYs or years of healthy life lost per year in Great Britain. However, this would underestimate the true extent of gambling harm as this does not consider the harm in affected others, legacy harm in former gamblers, and harm in under 16 gamblers.

  • Legislators, regulators, public health, and treatment providers should look to consider the extraordinary significance of gambling harm on the well-being of the GB population.

  • With a valuation of £20k - £30k per QALY as per NICE definitions of what may be considered cost-effective – 1.15m years of healthy life may justify treatments costing £23bn - £35bn.

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