Traumatic brain injury as an independent risk factor for problem gambling: a matched case-control study
To assess whether traumatic brain injury (TBI) increases the risks of subsequent problem gambling.
We conducted a matched case–control analysis of adults in Ontario, Canada. The study included those who self-reported their gambling activities in the Canadian Community Health Survey 2007–2008. Using Problem Gambling Severity Index, we defined cases as those who were problem gamblers and controls who were recreational gamblers. Cases were matched to controls 1:2 using propensity scores based on demographics, prior mental health, and self-reported behaviours. The main predictor was prior TBI defined as requiring emergency care and identified using ICD-10 codes from administrative health databases. We estimated the likelihood of prior TBI in problem gamblers compared to controls using conditional logistic regression.
Of 30,652 survey participants, 16,002 (53%) reported gambling activity of whom 14,910 (49%) were recreational gamblers and 4% (n = 1092) were problem gamblers. A total of 1469 respondents (5%) had a prior TBI. Propensity score matching yielded 2038 matched pairs with 1019 cases matched to 2037 controls. Case–control analysis showed a significant association between prior TBI and subsequent problem gambling (odds ratio 1.27, 95% confidence interval 1.07–1.51, P = 0.007). The increased risk was mostly apparent in men aged 35 to 64 years who reported alcohol use or smoking. The relative risk of problem gambling in those with two or more TBIs equated to an odds ratio of 2.04 (95% confidence interval 1.05–3.99).
We found that a prior TBI was associated with an increased subsequent risk of problem gambling. Our findings support more awareness, screening, and treating problem gambling risks among TBI patients.
KeywordsConcussion Head injury Pathological gambling
JAB, DT, and DAR had full access to the data and take responsibility for accuracy of data analysis. Study concept and design: All authors. Acquisition, analysis, or interpretation of data: All authors. Drafting of manuscript: JAB, DAR Statistical analysis: JAB, DT, DAR, Administrative support, obtained funding and supervision: Redelmeier.
This work did not receive any direct funding. DAR is Canada Research Chair in Decision Sciences.
Compliance with ethical standards
Conflict of interest
No conflicts of interests were identified for any of the authors.
The opinions, results, and conclusions of this manuscript are those of authors, and are independent of funding sources. No endorsement by the authors’ affiliate institutions or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred.
Data sharing statement
No additional data available.
Research ethics statement
The study methods were approved by the Research Ethics Board of the Sunnybrook Health Sciences Centre, both located in Toronto ON, Canada.
- 1.Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC (2007) The impact of traumatic brain injuries: a global perspective. NeuroRehabilitation 22(5):341–353Google Scholar
- 2.CDC National Center for Health Statistics (2014) National vital statistics system (NVSS), 2006–2010. Centers for Disease Control and Prevention, AtlantaGoogle Scholar
- 7.Allen S, Stewart SH, Cusimano M, Asbridge M (2016) Examining the relationship between traumatic brain injury and substance use outcomes in the canadian population. Subst Use Misuse 2:1–10Google Scholar
- 13.Shaffer HJ, Hall MN (2001) Updating and refining prevalence estimates of disordered gambling behaviour in the United States and Canada. Can J Pub Health = Revue canadienne de sante publique 92(3):168–172Google Scholar
- 15.Williams RJ, West BL, Simpson RI (2012) Prevention of problem gambling: a comprehensive review of the evidence and identified best practices. Report prepared for the ontario problem gambling research centre and the ontario ministry of health and long term care. University of Lethbridge, LethbridgeGoogle Scholar
- 16.Wiebe J, Single E, Falkowski-Ham A, Mun P (2004) Gambling and problem gambling among older adults in Ontario. Responsible Gambling Council and Canadian Centre on Substance Abuse, OttawaGoogle Scholar
- 17.Williams RJ, Volberg RA (2013) Gambling and problem gambling in Ontario. Ontario problem gambling research centre and the Ontario ministry of health and long term care, Toronto, ON. Available at https://www.uleth.ca/dspace/bitstream/handle/10133/3378/2013-GPG%20ONT-OPGRC.pdf. Accessed 01 Aug 2018
- 18.Korn DA (2000) Expansion of gambling in Canada: implications for health and social policy. CMAJ 11(1):61–64 163Google Scholar
- 19.Wiebe J, Mun P, Kauffman N (2006) Gambling and problem gambling in Ontario 2005. Responsible Gambling Council, TorontoGoogle Scholar
- 22.Problem Gambling Institute of Ontario (2009) Facts about problem gambling. Problem Gambling Institute of Ontario, TorontoGoogle Scholar
- 23.el-Guebaly N, Patten SB, Currie S et al (2006) Epidemiological associations between gambling behavior, substance use & mood and anxiety disorders. J Gambl Stud/co-sponsored by the National Council on Problem Gambling Institute for the Study of Gambling Commercial Gaming 22(3):275–287Google Scholar
- 32.Statistics Canada (2014) Population by year, by province and territory. Statistics Canada, OttawaGoogle Scholar
- 33.Ontario Ministry of Health and Long-Term Care (2014) Schedule of benefits for physician services under the health insurance act. Queen’s Printer for Ontario, TorontoGoogle Scholar
- 35.Statistics Canada (2008) Canadian Community Health Survey (CCHS) 2007 Questionnaire. Statistics Canada, OttawaGoogle Scholar
- 36.Statistics Canada (2008) Canadian Community Health Survey (CCHS) 2008 (Annual component) and 2007–2008: Derived Variable (DV) Specifications. Statistics Canada, OttawaGoogle Scholar
- 39.Ferris J, Wynne H (2001) The canadian problem gambling severity index: final report. Canadian Centre on Substance Abuse, OttawaGoogle Scholar
- 40.Walker M, Blaszczynski A, Braganza C et al (2011) Clinical assessment of problem gamblers identified using the canadian problem gambling index. Independent Gambling Authority, AdelaideGoogle Scholar
- 41.Marr AL, Coronado VG (2004) Central nervous system injury surveillance data submission standards—2002. US Department of Health and Human Services, AtlantaGoogle Scholar
- 46.Kuentzel JG, Henderson MJ, Melville CL (2008) The impact of social desirability biases on self-report among college student and problem gamblers. J Gamb Stud/co-sponsored by the National Council on Problem Gambling Institute for the Study of Gambling Commercial Gaming 24(3):307–319Google Scholar
- 50.King G, Nielsen R (2016) Why propensity scores should not be used for matching. Harvard University, CambridgeGoogle Scholar