[accordion start]
Full citation
Dowling, N. A., Merkouris, S. S., Greenwood, C. J., Oldenhof, E., Toumbourou, J. W., & Youssef, G. J. (2024). Global prevalence of problem gambling: A systematic review and meta-analysis. The Lancet Public Health, 9(7), e495–e507. https://doi.org/10.1016/S2468-2667(24)00126-9
[accordion end]
Region & Target Population
- Regions covered:
- North America
- Europe (Northern, Southern, Western, Eastern)
- Oceania (Australia & New Zealand)
- East Asia
- Sub-Saharan Africa
- Other global regions where data were available
- Population: General population samples (youth and adults)43
Study Design
- Systematic review and meta-analysis
- Conducted in accordance with PRISMA guidelines
- Pooled prevalence estimates using random-effects meta-analytic models
Study Characteristics
- Number of studies: 450+ prevalence studies (across multiple decades)
- Countries included: Over 70 countries worldwide
- Timeframe of studies: Predominantly 2000s–early 2020s
- Study types included:
- National surveys
- Regional population studies
- Measures: Multiple validated problem gambling instruments (e.g., PGSI, DSM-based tools)
Measures Used
- Gambling participation: Past-year or lifetime gambling prevalence
- Problem gambling: Standardized screening tools (PGSI, DSM criteria, SOGS variants)
- Regional classification: Countries grouped into global regions for pooled estimation
Research Questions
- What is the global prevalence of gambling participation and problem gambling?
- How do prevalence rates vary across world regions?
- Which regions show consistently higher or lower levels of gambling-related harm?
Key Findings (Cross-Regional Emphasis)
- Gambling participation: Highest overall participation rates were observed in North America and Europe, reflecting widespread availability and long-established gambling markets.
- Problem gambling prevalence:
- Oceania (Australia and New Zealand) showed the highest pooled prevalence of problem gambling, followed by parts of Southern Europe.
- Scandinavia and East Asia showed the lowest pooled prevalence, despite high participation in some gambling forms.
- Regional variation: Substantial heterogeneity existed within regions, but consistent regional patterns emerged across instruments and study designs.
- Emerging trends noted by the authors:
- Rapid growth of sports betting in parts of Africa, particularly among younger populations.
- Expansion of online gambling in Europe, altering exposure and access patterns.
Study Conclusion
The authors conclude that problem gambling prevalence varies markedly across world regions, and that these differences are not random. Instead, they reflect systematic variation in gambling availability, market maturity, regulatory environments, and cultural norms. Regions with long established, liberalized gambling markets particularly Oceania, show consistently higher levels of gambling-related harm. In contrast, regions with stronger regulatory controls or different gambling cultures tend to report lower prevalence.
Importantly, the authors emphasize that high gambling participation does not necessarily translate into high problem gambling prevalence, as illustrated by Scandinavian and East Asian contexts. This finding underscores the role of structural and policy factors, rather than participation alone, in shaping harm. The review cautions against treating gambling as a uniform global phenomenon and argues for region-specific prevention and regulatory responses informed by local gambling systems and cultural contexts. While the meta-analysis includes all age groups, the authors note that younger populations are frequently over-represented in emerging gambling markets and online environments, suggesting that young adults are likely to be disproportionately affected by regional shifts in availability and regulation.
A key conclusion is that gambling harm is not globally uniform, and therefore prevention and regulation must be region-specific, grounded in the characteristics of local gambling environments and public health infrastructure. They also highlight the importance of interpreting regional estimates cautiously due to measurement differences, while still recognizing that stable regional patterns emerge across a large evidence base.
