All‐cause and cause‐specific mortality in gambling disorder: Evidence from a nation‐wide matched and sibling cohort study in Taiwan

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.