Demographic and Comorbidity Characteristics of U.S. Veterans in a Retrospective Descriptive Matched Cohort Study Addressing Problematic Gambling

Introduction: Problematic gambling is an increasing public health concern that also affects U.S. Veterans. Problematic gambling in Veterans correlates with several other factors, including socio-economic issues like homelessness and legal problems, and mental health issues like post-traumatic stress disorder, and suicide attempt. Our objective was to analyze differences between U.S. Veterans experiencing problematic gambling compared to similar U.S. Veterans who did not, according to diagnostic codes. Materials and Methods: Electronic health records from the U.S. Department of Veterans Affairs (VA) for health care encounters between 2016-01-01 and 2024-12-31 served as data for this study. We performed a one-to-one match on age, race, ethnicity, gender, and VA station for 775 Veterans diagnosed with problematic gambling by International Classification of Diseases 10th edition codes, to Veterans not receiving one of the diagnostic codes relevant to gambling. We then compared comorbidity diagnoses, marital status, and VA care encounters, applying chi-squared and t-test analyses. Results: There were many statistically significant differences in care use, marital status, and comorbidities. Veterans with problematic gambling were more likely to experience other substance abuse, including opioid use disorder (22.5% vs 8.4%) and alcohol use disorder (56.3% vs 25.9%). Veterans with problematic gambling were also more likely to experience mental illness, including major depressive disorder (64.9% vs 46.7%), post-traumatic stress disorder (50.8% vs 43.1%), and suicide attempt (5.3% vs 3.0%), and socio-economic issues, including economic hardship (28.7% vs 16.3%), homelessness (33.9% vs 14.8%), legal problems (13.4% vs 6.8%) and social/family problems (53.6% vs 46.5%). Veterans experiencing problematic gambling also were less likely to be married and received more VA outpatient care. Conclusions: The findings suggest that problematic gambling in Veterans correlates with worse outcomes when comparing similar Veterans receiving care through the same facilities. It is feasible to screen for problematic gambling in primary care encounters, however the extent of screening in VA care is unknown. Screening for problematic gambling in VA primary care may enable providers to assist patients experiencing problematic gambling to find directed care.