Burden Of Erectile Dysfunction Research Articles

Umbrella review protocol: Global burden and risk factors of erectile dysfunction in diabetic population.

Erectile dysfunction (ED) is no longer a whisper in the shadows; it's a rising tide threatening the sexual health of millions of men in different regions. This worrying trend shows no signs of slowing down, with projections claiming a staggering 322 million men globally could be affected in the near future. In the cases of diabetes, the condition worsens and has a potent cocktail of physical and psychological distress, chipping away at men's confidence, self-esteem, and mental health. This urgent issue demands immediate attention and action. Thus, this umbrella review intended to estimate the current burden of ED and associated risk factors among diabetic patients in the global context. Following PRISMA guidelines will be searched for relevant Systematic Review and Meta-analysis studies in PubMed, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. The quality of the included studies will be assessed using the new regress tool, the Assessment of Multiple Systematic Reviews 2 tool. To estimate the pooled prevalence of ED, we will employ a weighted inverse variance random-effects model. We will further conduct subgroup analyses, assess heterogeneity and publication bias, and perform sensitivity analyses to strengthen the robustness of our findings. Prediction intervals will also calculated to estimate the range within which future observations will likely fall. In all statistical analyses, the statistical significance will be declared at p value < 0.05. This umbrella review of systemic review and meta-analysis will be the first to systematically explore and integrate evidence regarding the burden of ED and associated risk factors in the diabetic population in a global context. By estimating the worldwide burden and identifying risk factors of ED in this population, the study will contribute to uncovering the hidden burden. Thereby, the issue will get international attention to reduce its consequences on the sexual health of the diabetic population. Besides, it will also provide input and direction for future research outlook.

Erectile Dysfunction in a U.S. National Sample of Male Military Veterans.

Erectile dysfunction (ED) is one of the most prevalent sexual dysfunctions in men and often co-occurs with physical and mental health issues. Military veterans are at elevated risk for many comorbid physical and mental health issues, including ED, although little research has examined the prevalence and health burden of ED in the general U.S. veteran population. The present study calculated the weighted lifetime prevalence of ED and its association with physical and mental health conditions in a nationally representative sample of U.S. veterans. Using data from a nationally representative sample of 921 male U.S. veterans, self-report assessments assessed major depressive disorder (MDD), generalized anxiety disorder, probable post-traumatic stress disorder (PTSD), at-risk/problem gambling, and past two-week suicidal ideation and attempts, as well as 22 physical health conditions. The weighted lifetime prevalence of ED among veterans was 14.2% (95% CI = 12.0%-16.0%). Veterans with ED were more likely to be older than 60, unemployed, to have served less than four years in the military, and to have served in combat roles and in the Vietnam War. Relative to veterans without ED, veterans with ED had higher rates of sleep disorders (adjusted odds ratio [aOR] = 3.23), arthritis (aOR = 2.60), high cholesterol (aOR = 2.30), diabetes (aOR = 2.29), high blood pressure (aOR = 2.14), obesity (aOR = 2.12), heart disease (aOR = 2.10), cancer (aOR = 2.07), respiratory illness (aOR = 2.02), and chronic pain (aOR = 1.86). After adjusting for sociodemographic characteristics and physical health conditions, ED was associated with increased odds of MDD (aOR = 2.88), at-risk/problem gambling (aOR = 2.45), and suicidal ideation (aOR = 1.91) but not for generalized anxiety disorder (aOR = 1.69) or probable PTSD (aOR = 1.63). When considered in the context of all mental health variables, MDD was independently associated with ED (aOR = 3.39). This study examined both mental and physical health conditions associated with ED in a U.S. nationally representative sample of veterans. ED is prevalent in veterans and associated with elevated physical and mental health burden. Results highlight the importance of considering ED in disease prevention and treatment efforts in this population. These findings may help inform prevention approaches as well as clinical targets for early screening and treatment in vulnerable subgroups of this population. Notably, data collected relied on self-report assessments; data on race and socioeconomic status were not collected.

Genes Predisposing to Erectile Dysfunction and Management: A Review

Abstract Background: The burden of erectile dysfunction (ED) is rising worldwide due to unresponsiveness of some affected individuals to existing drugs and treatment strategies. Fortunately, improvement in biological techniques has led to the understanding that some cases of the disorder may have a genetic etiology, which, when fully understood, may lead to improved treatment. Objective: This review articulated established ED candidate genes and pathophysiology to assist researchers and medical practitioners to formulate effective drugs and treatment procedures. Methods: The Google search engine was used to retrieve relevant information on the topic from reputable academic databases, including PubMed, Medline, Google Scholar, Scopus, and SpringerLink. Results: The search discovered 10 ED candidate genes, which are SIM1, SLC6A4, 5-HTTLPR, TGFB1, DAT1, MC4R, NOS3, GNB3, AR, and MTHFR. Polymorphisms or mutations in these genes may disrupt erectile activities of the hypothalamus, neurotransmitters such as dopamine, serotonin, and nitric oxide as well as relaxation of penile tissues. Clinical presentations of ED include loss of erection, weak vaginal penetration, premature ejaculation, and anejaculation. Each gene has a distinct mechanism, which, if targeted in the affected may reverse the disorder or reduce the effects. Conclusion: Some cases of ED are genetic, which, when fully understood, may give an insight into new treatment procedures or improve on the current ones. Medical practitioners are advised to formulate treatment procedures that target the affected gene (s) in individuals.

MP27-08 CLINICAL CORRELATES AND ECONOMIC CONSEQUENCES OF EMPLOYER BENEFIT EXCLUSION FOR PENILE PROSTHESIS IMPLANTATION FOR ERECTILE DYSFUNCTION

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation I (MP27)1 Sep 2021MP27-08 CLINICAL CORRELATES AND ECONOMIC CONSEQUENCES OF EMPLOYER BENEFIT EXCLUSION FOR PENILE PROSTHESIS IMPLANTATION FOR ERECTILE DYSFUNCTION Sirikan Rojanasarot, Samir Bhattacharyya, and Arthur L. Burnett Sirikan RojanasarotSirikan Rojanasarot More articles by this author , Samir BhattacharyyaSamir Bhattacharyya More articles by this author , and Arthur L. BurnettArthur L. Burnett More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002024.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Employed men with erectile dysfunction (ED) covered by employer-sponsored health insurance (ESHI) often have limited access to penile prosthesis implantation (PPI). This study quantified the clinical correlates and economic consequences of the benefit exclusion by examining the prevalence and comorbid correlations of ED among men with ESHI; the population size of ED men affected by the issue; and the economic impact of work productivity loss due to benefit exclusion for PPI. METHODS: A cost-consequence analysis was developed to quantify the impact of employer exclusion for PPI. The analysis was selected as it displays results in natural units of effect, including the number of men affected and the days and costs of work productivity lost, enabling clinicians and decision makers to select the most relevant components to them. IBM MarketScan Commercial data from 2010-2018 were analyzed to determine the prevalence and comorbid correlations of ED. The American Community Survey and published literature were used to estimate the number of ED men with ESHI affected by benefit exclusion for PPI. The economic impact of work productivity loss due to ED was calculated using National Occupational Employment and Wage Estimates and converted into 2019 US dollars. RESULTS: The prevalence rates of ED among men with ESHI increased from 1.6% in men aged 18-24 years to 24.6% in men aged 55-64 years (Figure). Most ED men were ≥45 years of age (78.5%), had a Charlson Comorbidity Index of 0 (76.1%). Common comorbidities were hyperlipidemia (48.0%) and hypertension (46.4%). An estimated 1.29 million men with ESHI in 2019 were affected by benefit exclusion for PPI. Men with ED had an additional 283 hours/year of work impairment compared to men without ED, resulting in an annual indirect mean cost of $7,270. An average US company with 5,000 employees that excluded PPI from their plan could lose $1.28 million of work productivity due to additional work impairment from ED. CONCLUSIONS: The extent of men with ED affected by benefit exclusion for PPI as well as economic impact of work productivity loss due to this exclusion issue are substantial. Removing benefit exclusion for PPI may improve patient access to effective ED treatment and reduce the burden of ED on both patients and employers . Source of Funding: Boston Scientific © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e474-e474 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sirikan Rojanasarot More articles by this author Samir Bhattacharyya More articles by this author Arthur L. Burnett More articles by this author Expand All Advertisement Loading ...

The Quality of Life and Economic Burden of Erectile Dysfunction.

Erectile dysfunction (ED) is a common disorder in adult males that results in withdrawal from sexual intimacy, psychosocial problems (ie, poor self-esteem, depression, anxiety), decreased work productivity, and reduction in quality of life for both the men suffering from ED and their female partners. A pragmatic literature review was undertaken using PUBMED to identify original research studies published over the past 20 years that assessed the impact of ED on a male’s quality of life, the impact of ED on a female partner’s quality of life, or the economic impact of ED on employers. Twenty studies were selected for inclusion. This review showed that men with ED have a poorer quality of life than men without ED (n=9 studies). Results from a global burden of illness study showed that men with ED report substantially lower SF-36 Mental and Physical Component Summary scores and SF‐6D scores compared to men without ED (p<0.001). Similarly, the partner is also negatively impacted by ED due to relationship difficulties and decreased sexual satisfaction (n=8 studies). Results from the Female Experience of Men’s Attitudes to Life Events and Sexuality study showed that females were significantly less satisfied and engaged in sexual activity less frequently after their partner developed ED (p<0.001). ED also poses a substantial economic burden on employers (n=3 studies). An observational study in men aged 40–70 showed that men with ED had significantly higher rates of absenteeism (2x) and work productivity impairment compared to men without ED (p<0.001). Overall, this contemporary review demonstrated that ED imposes a substantial quality of life burden on men and their female partners as well as a significant economic burden on their employers. These findings underscore the need for more education and awareness of the burden of ED and greater access to appropriate ED treatments to help alleviate this burden.

Prevalence of erectile dysfunction and associated factors among males visiting family medicine clinics in a Tertiary Care Hospital in Karachi, Pakistan.

Background:The burden of erectile dysfunction (ED) among the developed countries is found to be quite high. However, there is a paucity of data among developing countries to know its actual burden and factors associated with it.Methods:The current study is cross-sectional and was conducted in Family Medicine clinics of Liaquat National Hospital during May 2017–January 2018. A total of 450 males participated in this study with the age range of 24–77 years. More than half of the participants were graduates or above.Results:On multivariable analysis, age (aOR = 5.47, 95% CI: 2.74–10.89), alcohol use (aOR = 5.23, 95% CI: 1.45–18.84), diabetes (aOR = 6.61, 95% CI: 3.27–13.36), and current smoking (OR = 2.41, 95% CI: 1.35–4.31) were significantly associated with ED. ED risk was significantly lower in those who either attended secondary school (aOR = 0.33, 95% CI: 0.13–0.88) or were at least graduates (aOR = 0.40, 95% CI: 0.17–0.96) than illiterate when model was adjusted for other covariates.Conclusion:Erectile dysfunction in a Pakistani male population highlights the need for routine screening at the primary care level. There is a possibility that the actual burden is underreported due to cultural stigmatization; hence, further research is warranted to validate the findings.

Addressing Health-Care System Inequities in the Management of Erectile Dysfunction: A Call to Action.

Erectile dysfunction (ED) is a common, burdensome, and costly urologic condition strongly related to all aspects of general health, from physical to mental. ED has profound consequences as it may interfere physical well-being, quality of life (QoL), self-esteem, relationships, self-worth, and productivity. It is therefore important to ensure that all types of effective ED treatments are consistently accessible to patients. While federal and state mandates ensure access to treatment for women’s breast health, female-factor infertility, and gender affirmation to ensure that these individuals do not experience a diminished QoL, there are no comparable mandates for men’s sexual and reproductive health. The burden of ED necessitates a call to action to improve the accessibility of ED treatments. The call to action steps include: (a) coverage for pharmacological, surgical, and other ED treatments should be viewed in the same way as coverage for other health issues, whether male or female and regardless of the stages of treatment, physical dysfunction, or physical changes; (b) American Urological Association (AUA) guidelines for the management of ED should be followed, including implementation of templates in electronic medical records (EMRs) to support adherence to the guidelines; and (c) coverage criteria should explicitly state that the criteria are intended to support gender equity for sexual and reproductive health care and should not be used to prevent men from receiving medically necessary ED treatments. This call to action offers a pathway to support every man who seeks treatment for ED as a medically necessary intervention by removing systemic health-care barriers.

Erectile dysfunction in diabetes mellitus: A review

The International Diabetes Federation estimates that globally there are 425 million people with diabetes. Estimates of the prevalence of erectile dysfunction (ED) in men with diabetes range from 20% to 85% in different studies. Among men with ED, those with diabetes are likely to experience the problem 10–15 years earlier than men without diabetes. This review aims to provide an update of the epidemiology, pathophysiology and management of ED in diabetes patients in India. The proposed mechanisms of ED in diabetic patients include elevated advanced glycation end-products and increased levels of oxygen-free radicals, impaired nitric oxide (NO) synthesis, increased endothelin B receptor binding sites and ultrastructural changes, upregulated RhoA/Rho-kinase pathway, NO-dependent selective nitrergic nerve degeneration and impaired cyclic guanosine monophosphate-dependent kinase-1. Modifiable risk factors for ED include smoking, lack of physical activity, wrong diets, overweight or obesity, metabolic syndrome and excessive alcohol consumption. Therefore, the promotion of healthful lifestyles would yield great benefits in reducing the burden of ED. The treatment of diabetic ED is multimodal. The treatment of the underlying hyperglycaemia and comorbidities is of utmost importance to prevent the progression of the disease. The peripherally acting oral phosphodiesterase type 5 inhibitors are the mainstay of oral medical treatment of ED in diabetics. Vacuum erection devices are an additional a non-invasive treatment option. The local administration of vasoactive medication through urethral suppository or intracorporal injection can be effective with minimal side-effects.

Erectile Dysfunction Treatment Following Radical Cystoprostatectomy: Analysis of a Nationwide Insurance Claims Database

IntroductionTo improve care for patients after radical cystoprostatectomy (RCP), focus on survivorship issues such as sexual function needs to increase. Previous studies have demonstrated the burden of erectile dysfunction (ED) after RCP to be as high as 89%. AimTo determine the rates of ED treatment use (phosphodiesterase type 5 inhibitors, injectable therapies, urethral suppositories, vacuum erection devices, and penile prosthetics) in patients with bladder cancer before and after RCP to better understand current patterns of care. MethodsMen with bladder cancer undergoing RCP were identified in the MarketScan database (2010–2014). ED treatment use was assessed at baseline (during the 1 year before RCP) and at 6-month intervals (0–6, 7–12, 13–18, 19–24 months) after RCP. Multivariable logistic regression models were used to identify predictors of ED treatment use at 6-month intervals after RCP. OutcomesED treatment rates and predictors of ED treatment at 0–6, 7–12, 13–18, 19–24 month follow-up after RCP. ResultsAt baseline, 6.5% of patients (77 of 1,176) used ED treatments. The rates of ED treatment use at 0 to 6, 7 to 12, 13 to 18, and 19 to 24 months after RCP were 15.2%, 12.7%, 8.1%, and 10.1% respectively. Phosphodiesterase type 5 inhibitors were the most commonly used treatment at all time points. In the multivariable model, predictors of ED treatment use at 0 to 6 months after RCP were age younger than 50 years (odds ratio [OR] = 3.17, 95% CI = 1.68–6.01), baseline ED treatment use (OR = 5.75, 95% CI = 3.08–10.72), neoadjuvant chemotherapy (OR = 1.72, 95% CI = 1.13–2.61), and neobladder diversion (OR = 2.40, 95% CI = 1.56–3.70). Baseline ED treatment use continued to be associated with ED treatment use at 6 to 12 months (OR = 5.63, 95% CI = 2.42–13.10) and 13 to 18 months (OR = 8.99, 95% CI = 3.05–26.51) after RCP. Clinical ImplicationsWhile the burden of ED following RCP is known to be high, overall ED treatment rates are low. These findings suggest either ED treatment is low priority for RCP patients or education about potential ED therapies may not be commonly discussed with patients following RCP. Urologists should consider discussing sexual function more frequently with their RCP patients. Strengths & LimitationsStrengths include the use of a national claims database, which allows for longitudinal follow-up and detailed information on prescription medications and devices. Limitations include the lack of pathologic and oncologic outcomes data. ConclusionED treatment use after RCP is quite low. The strongest predictor of ED treatment use after RCP was baseline treatment use. These findings suggest ED treatment is a low priority for patients with RCP or education about potential ED therapies might not be commonly discussed with patients after RCP. Urologists should consider discussing sexual function more frequently with their patients undergoing RCP.Chappadi MR, Kates M, Sopko NA, et al. Erectile Dysfunction Treatment Following Radical Cystoprostatectomy: Analysis of a Nationwide Insurance Claims Database. J Sex Med 2017;14:810–817.

Burden of Sexual Dysfunction

Similar to the burden of other diseases, the burden of sexual dysfunction has not been systematically studied. However, there is growing evidence of various burdens (e.g., economic, symptomatic, humanistic) among patients suffering from sexual dysfunctions.The burden of sexual dysfunction has been studied a bit more often in men, namely the burden of erectile dysfunction (ED), premature ejaculation (PE) and testosterone deficiency syndrome (TDS). Erectile dysfunction is frequently associated with chronic conditions such as cardiovascular disease, diabetes, and depression. These conditions could go undiagnosed, and ED could be a marker of those diseases. The only available report from the United Kingdom estimated the total economic burden of ED at £53 million annually in terms of direct costs and lost productivity.The burden of PE includes significant psychological distress: anxiety, depression, lack of sexual confidence, poor self-esteem, impaired quality of life, and interpersonal difficulties. Some suggest that increase in female sexual dysfunction is associated with partner's PE, in addition to significant interpersonal difficulties. The burden of TDS includes depression, sexual dysfunction, mild cognitive impairment, and osteoporosis. One UK estimate of the economic burden of female sexual dysfunctions demonstrated that the average cost per patient was higher than the per annum cost of ED. There are no data on burden of paraphilic disorders.The burden of sexual dysfunctions is underappreciated and not well studied, yet it is significant for both the patients and the society.

The burden of erectile dysfunction in dialysis patients in Senegal

Erectile dysfunction (ED) is very common in dialysis patients because of organic and psychological risk factors. It has a negative impact on patients' quality of life. In Senegal, ED is assumed to be frequent in the general adult population but its prevalence in dialysis patients is unknown. This cross-sectional study aimed to assess the prevalence and risk factors associated with ED in Senegalese dialysis patients. Seventy dialyzed men >18 years old were included. Erectile dysfunction was assessed using the abridged version of International Index of Erectile Function already validated in dialysis patients. Multivariate analysis was performed to identify the factors associated with ED in patients. The mean age of the patients was 52 ± 11.3 years (21-70 years) and the median dialysis vintage was 39.4 months (interquartile range 9-51 months). The prevalence of ED was 81.5% for all patients (80% in hemodialysis and 81.75% in peritoneal dialysis). Severe ED was found in 11.5% of patients. The prevalence of ED was 74.5% in patients younger than 50 years and 86.6% in those 50 years or older. Marital status, comorbidity, hemoglobin level, and use of antihypertensive drugs were not different between patients with and without ED. Libido was conserved in 77% of patients and 44.7% were not satisfied during sexual intercourse. Multivariate analysis identified age and dialysis vintage as risk factors of ED in our patients. Only 7 patients received treatment for ED and 22% sought a consultation with a specialist (urologist and psychologist).

Beratung zur erektilen Dysfunktion während stationärer Rehabilitation nach radikaler Prostatektomie

For men erectile function is essential for quality of life. Besides urine incontinence postsurgical erectile dysfunction (ED) following radical prostatectomy (RPE) represents a significant and prevalent problem. One of the first approaches to this condition should be a consultation performed by professionals in a rehabilitation clinic.A total of 149 patients post RPE participated in this prospective study. All patients were questioned about their understanding of postoperative surgical ED after RPE and if affected they were asked about their own psychological burden as well as their knowledge of possible therapy options. The qualities of presurgical patient information as well as the modules of information pertaining to ED during the rehabilitation were evaluated. Of the patients, 53% expressed that they experienced a considerable burden due to postsurgical ED during their follow-up rehabilitation (AR group) and 70% of the patients during oncological rehabilitation treatment (rehab group). Men who were sexually more active prior to surgery suffered more from postsurgical ED than their less active counterparts. A negative correlation between psychological burden and age was found in the AR group, which however was levelled in the rehab group. Particularly in older patients the burden of ED increases with more time elapsing after the operation. The medical information on ED therapy options provided during the inpatient rehabilitation was considered to be essential by 60% of the men in the AR group and 48% of the patients in the rehab group.Therapeutic possibilities for postsurgical ED following RPE cannot always be given to patients in the preoperative phase or during their stay in the hospital. Since however a large majority of men suffer from postoperative ED following RPE a specialized inpatient urological rehabilitation is suited for a comprehensive consultation.

Racial Disparities in Erectile Dysfunction among Participants in the California Men's Health Study

The burden of erectile dysfunction (ED) among different racial and ethnic groups is unclear, in part, because prior studies have not included all four major racial and ethnic groups in the same population-based sample. To determine the prevalence and odds of ED among all four major racial and ethnic groups after adjustment for demographic, medical, socioeconomic, and lifestyle characteristics. This cross-sectional study was conducted using data from men, aged 45-69 years, without a diagnosis of prostate cancer (N = 78,445), who completed questionnaires as part of the California Men's Health Study, a large multiethnic cohort study with detailed demographic, medical and, socioeconomic data. Erectile dysfunction measured by a previously validated four-level response question. The overall prevalence of ED by age category was 13%, 24%, and 44% for men aged 45-49 years, 50 and 59 years, and 60-69 years, respectively. In a multivariable model, relative to white men, Hispanic (OR 1.05, 95% CI 0.99, 1.12), Asian (OR 1.1, 95% CI 1.02, 1.19), and other men (OR 1.13, 95% CI 1.06, 1.1.21) had increased odds of moderate-severe ED, while black men were less likely to report moderate to severe ED (OR 0.86, 95% CI 0.81, 0.92). Black (OR 0.54, 95% CI 0.48, 0.61) and Asian men (OR 0.91, 95% CI 0.80, 1.04) were less likely to have severe ED after adjustment for age, socioeconomic status, medical co-morbidities, and lifestyle characteristics. These data demonstrate that the prevalence of ED among different racial and ethnic groups is likely the result of complex phenomena and depends upon the interplay of socioeconomic, demographic, medical, cultural, and lifestyle characteristics. After accounting for these factors, these data suggest that Asian and black men are less likely to have severe ED relative to white men.

DO DISPARITIES IN UTILIZATION OF PARTIAL NEPHRECTOMY OCCUR AT A TERTIARY REFERRAL CENTER?

INTRODUCTION AND OBJECTIVE: Few population-based studies have assessed variations in the burden of erectile dysfunction (ED) by race/ethnicity. The purpose of this analysis is to estimate prevalence rates of ED by race/ethnicity and determine the contribution of behavioral risk factors, chronic illnesses, and socioeconomic factors to potential race/ethnic differences in ED. METHODS: The Boston Area Community Health (BACH) Survey is a study of urologic symptoms in a racially and ethnically diverse population. BACH used a multistage stratified random sample to recruit 2301 men age 30-79 years from the city of Boston. ED was assessed using the validated 5-item International Index of Erectile Function. Selfreported race/ethnicity was defined as Black, Hispanic, and White. Socioeconomic status (SES) was defined as a combination of education and household income. RESULTS: Overall prevalence of ED was 20.7% with higher prevalence observed among both Black men (24.9%) and Hispanic men (25.3%) compared to White men (18.1%). Increased odds of ED were observed for both Black and Hispanic men after adjusting for age, comorbid conditions (cardiovascular disease, diabetes, depression), and behavioral risk factors (smoking, physical activity, alcohol use). After controlling for the effect of SES, the association between race/ethnicity and ED disappeared. In contrast, men in the low SES category had an over two-fold increase in risk of ED (adjusted OR of 2.52, 95%CI: 1.63, 2.91). CONCLUSIONS: Findings from this study demonstrate that, after appropriate statistical control, SES accounts for differences in ED prevalence previously attributed to race/ethnicity.

Socioeconomic Status, Not Race/Ethnicity, Contributes to Variation in the Prevalence of Erectile Dysfunction: Results from the Boston Area Community Health (BACH) Survey

Few population-based studies have assessed variations in the burden of erectile dysfunction (ED) by race/ethnicity. To estimate prevalence rates of ED by race/ethnicity and determine the contribution of behavioral risk factors, chronic illnesses, and socioeconomic factors to potential race/ethnic differences in ED. The Boston Area Community Health (BACH) Survey is a study of urologic symptoms in a racially and ethnically diverse population. BACH used a multistage stratified random sample to recruit 2,301 men aged 30-79 years from the city of Boston. Self-reported race/ethnicity was defined as Black, Hispanic, and White. Socioeconomic status (SES) was defined as a combination of education and household income. ED assessed using the 5-item International Index of Erectile Function (IIEF-5). IIEF-5 scores were used both as a continuous variable and dichotomized as </=16 vs. >/=17. Overall prevalence of ED (defined as an IIEF-5 score </=16) was 20.7% with higher prevalence observed among both Black men (24.9%) and Hispanic men (25.3%) compared to White men (18.1%). Increased odds of ED were observed for both Black and Hispanic men after adjusting for age, comorbid conditions (cardiovascular disease, diabetes, depression), and behavioral risk factors (smoking, physical activity, alcohol use). After controlling for the effect of SES, the association between race/ethnicity and ED disappeared. In contrast, men in the low SES category had an over two-fold increase in risk of ED (adjusted odds ratio of 2.26, 95% confidence interval 1.39, 3.66). The increased risk of ED in Black and Hispanic men is associated with differences in SES rather than differences in known risk factors of ED.

Predictors and Prevalence of Erectile Dysfunction in a Racially Diverse Population

To our knowledge, the burden of disease attributed to erectile dysfunction (ED) has not been adequately quantified across a complete spectrum of age and race using a global disease definition, as recommended by the National Institutes of Health consensus statement. To obtain a better understanding of the national estimates of prevalence and risk factors for ED, we analyzed data from the 2001-2002 National Health and Nutrition Examination Survey. The National Health and Nutrition Examination Survey collects data by household interview. The sample design is a stratified, multistage, probability sample of clusters of persons representing the civilian noninstitutionalized population. Data include medical histories in which specific queries are made regarding urological symptoms (including ED). These items were selected for analysis in 3566 men, 20 years and older. In men 20 years and older, ED affected almost 1 in 5 respondents. Hispanic men were more likely to report ED (odds ratio [OR], 1.89), after controlling for other factors. The prevalence of ED increased dramatically with advanced age; 77.5% of men 75 years and older were affected. In addition, there were several modifiable risk factors that were independently associated with ED, including diabetes mellitus (OR, 2.69), obesity (OR, 1.60), current smoking (OR, 1.74), and hypertension (OR, 1.56). The burden of ED on the US population is significant. Hispanic men had an elevated risk for ED, a finding that requires confirmation in prospective studies. Obesity, hypertension, smoking, and diabetes mellitus are significantly associated with ED risk. Mitigation of these risk factors may ameliorate the burden of ED.

Epidemiology of erectile dysfunction: results of the 'Cologne Male Survey'.

The last few decades have seen a marked increase in mean life expectancy in Central Europe. This has made elderly people and their quality of life a matter of ever-increasing medical concern. Available data from the United States and Scandinavia relating to erectile dysfunction (ED) do not enable us to draw valid conclusions about the current situation in Germany. The aim of the present study was to evaluate the epidemiology of male sexuality in Germany, and the proportion of men who need medical treatment because of increased suffering from this.A newly developed and validated questionnaire on male erectile dysfunction was mailed to a representative population sample of 8000 men, 30-80 y of age in the Cologne urban district. The response included 4489 evaluable replies (56.1%). The response rates in different age groups ranged from 49.2% to 68.4%. Regular sexual activity was reported by 96.0% (youngest age group) to 71.3% (oldest group). There were 31.5%-44% of responders who were dissatisfied with their current sex life. The prevalence of ED was 19.2%, with a steep age-related increase (2.3-53.4%) and a high co-morbidity of ED with hypertension, diabetes, pelvic surgery and 'lower urinary tract symptoms'. When treatment need was defined by co-occurrence of ED and dissatisfaction with sex life, 6.9% men required treatment for ED. Oral treatment of ED was preferred by 73.8% of respondents. There were 46.2% respondents who were willing to contribute more than DM 50 (25 Euro) per month for ED treatment. We conclude that regular sexual activity is a normal finding in advanced age. ED is a frequent disorder, contributing to dissatisfaction with sex life in a considerable proportion of men. The high burden of ED is reflected in willingness to pay for treatment. ED is frequently associated with chronic diseases. Therefore adequate diagnostic workup is essential, to offer patients individually adapted treatment. General non-reimbursability of treatment for ED appears to be unacceptable.