(116) Comorbidity Profile Network Analysis of Men with Erectile Dysfunction

Abstract

Abstract Introduction The modern understanding of the comorbidities associated with erectile dysfunction (ED) has been shaped by the findings of decades-old survey-based epidemiologic studies. The demographic structure and comorbidities of the United States population have since changed. A contemporary assessment of the comorbidity profile of men with ED is timely and indispensable for the efficient care of these men. Objective The objectives are to describe the comorbidity profile of a contemporary cross-section of men with erectile dysfunction, to identify clinically meaningful health trends, and to evaluate whether clusters of men with distinct comorbidity profiles can be discerned. Methods A cross-sectional analysis of the MarketScan® administrative claims database from 2008 to 2019 was performed. Inclusion criteria were men 18 to 64 years of age with a diagnosis of ED or phosphodiesterase type 5 inhibitor (PDE5i) prescription with at least 1 year of enrollment before the index date, as well as age-matched controls without an ED diagnosis or related prescription. Comorbidities were extracted by ICD-9/10 diagnosis codes and categorized by the Elixhauser Comorbidity Index. The trends in prevalence of comorbidities and odds of comorbidity diagnosis, overall and by age group, were analyzed. To elucidate the relationships between common comorbidities, a novel comorbidity network was performed with comorbidity strength estimated by observed-to-expected ratio (OER) of disease (prevalence > 0.01) in pairs with a comorbid prevalence > 0.001. Results The prevalence of all comorbidities in men with and without ED increased over the study period. The five most prevalent comorbidities (and percentage increase) among men with ED were hypertension (108%), diabetes without complication (78%), obesity (357%), chronic pulmonary disease (124%), and depression (164%) (Figure 1). The association of ED with comorbidities such as complicated diabetes and paralysis tended to be more pronounced among men in the younger cohort (18-45 years of age, vs 46-64 years of age) (Figure 2). Between 2008 and 2014, a generalized increase in the strength of association of ED with prevalent comorbidities is observed (Figure 3). Conclusions The comorbidity profile of men with ED has evolved since its initial characterization nearly 30 years ago. Increases in comorbidities associated with obesity and metabolic syndrome, as well as mental health disorders, are particularly notable. The findings illustrate the complex interplay of chronic health conditions in men with ED, and serve to justify the comprehensive evaluation of men of all ages who present with ED. Disclosure No