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Gambling and Subsequent Road Traffic Injuries

A Longitudinal Cohort Analysis

Bhatti, Junaid A., MBBS, MSc, PhD; Thiruchelvam, Deva, MSc; Redelmeier, Donald A., MD, MSHSR, FRCP (C), FACP

doi: 10.1097/ADM.0000000000000465
Original Research

Background: To compare the risks of a road traffic injury (RTI) crash among adults who were involved in high-risk gambling and those who did not gamble.

Methods: We conducted a linked longitudinal cohort analysis of adult persons in large population survey conducted during 2007 and 2008 in Ontario, Canada. We used responses to Problem Gambling Severity Index to distinguish persons as nongamblers, no-risk, low-risk, or high-risk gamblers. All persons were subsequently monitored for a subsequent RTI crash as a driver, pedestrian, or bicyclist up to March 31, 2014, through health insurance databases. We estimated relative risks as rate ratios (RRs) with 95% confidence intervals (95% CIs).

Results: In all, 30,652 adults were included, of whom 52% self-identified as gamblers, including 49% as no-risk gamblers, 2% as low-risk gamblers, and 1% as high-risk gamblers. During a median follow-up period of 6.8 years, 708 participants (2%) were involved in 821 RTI crashes. The absolute risks of an RTI were 6.4 per 1000 person-years (95% CI 3.7–10.4) in high-risk gamblers and 3.6 per 1000 person-years (95% CI 3.2–4.0) in nongamblers. The relative risks for RTI crashes were significantly higher in high-risk gamblers than in nongamblers (adjusted RR 1.68, 95% CI 1.03–2.76). The risks for RTI crashes as a driver were augmented in high-risk gamblers than in nongamblers (RR 1.97, 95% CI 1.13–3.43).

Conclusions: We found an increased risk of an RTI crash among drivers who self-identified as high-risk gamblers. Further research exploring the underlying mechanisms of these associations might interest health professionals to monitor RTI risks in adults involved in high-risk gambling.

Sunnybrook Research Institute, Evaluative Clinical Sciences, Toronto, Canada (JAB, DAR); University of Toronto, Departments of Surgery and Medicine, Toronto, Canada (JAB, DAR); Institute for Clinical Evaluative Sciences, Toronto, Canada (JAB, DT, DAR).

Send correspondence to Junaid A. Bhatti, MBBS, MSc, PhD, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, G106, Toronto, ON M4N 3M5, Canada. E-mail:

Received 2 May, 2018

Accepted 18 September, 2018

The study methods were approved by the Privacy Impact Services, Institute for Clinical Evaluative Sciences (ICES) and the Research Ethics Board of the Sunnybrook Health Sciences Centre, both located in Toronto, ON, Canada.

Authors’ contributions: Drs Bhatti and Redelmeier 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: Bhatti and Redelmeier. Statistical analysis: Bhatti, Redelmeier, and Thiruchelvam. Administrative support, obtained funding, and supervision: Redelmeier.

Funding: This work was supported by Sunnybrook Research Institute intramural funds. Investigators were supported by the Canadian Institutes of Health Research, Canada Research Chair in Medical Decision Sciences (Redelmeier). The funding agencies had no role in study design, conduct, analysis, and dissemination of findings.

All authors declare no competing interests.

© 2019 American Society of Addiction Medicine