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Risk factors for erectile dysfunction in a cohort of 108 477 Australian men

Med J Aust 2013; 199 (2): 107-111. || doi: 10.5694/mja12.11548

Summary

Objectives: To quantify relationships between erectile dysfunction (ED), ageing and health and lifestyle factors for men aged 45 years and older.

Design: Cross-sectional, population-based study seeking data on health, sociodemographic and lifestyle factors by questionnaire (the 45 and Up Study).

Participants and setting: 108 477 men aged 45 years or older, living in New South Wales, and recruited into the 45 and Up Study between 10 January 2006 and 17 February 2010.

Main outcome measures: Self-reported ED.

Results: In the 101 674 men reporting no prior diagnosis of prostate cancer, 39.31% (95% CI, 39.01%–39.61%) had no ED, 25.14% (95% CI, 24.87%–25.40%) had mild ED (ie, experienced ED sometimes), 18.79% (95% CI, 18.55%–19.03%) had moderate (ie, usually experienced) ED and 16.77% (95% CI, 16.55%–17.00%) had complete ED. After adjusting for sociodemographic characteristics, the odds of moderate/complete ED increased by 11.30% (OR, 1.11; 95% CI, 1.11–1.12) each year from the age of 45 years. Overall, the risk of moderate/complete ED was higher among men with low socioeconomic status, high body mass index, those who were sedentary, current smokers and those with diseases including diabetes, heart disease, and depression/anxiety, compared with men without these risk factors. Moderate alcohol consumption was associated with a significantly reduced risk of ED in men aged 45–54 years, but not in older men. Almost all men aged 75 or older reported moderate/severe ED; however, increased physical activity was associated with a lower odds of ED in this group.

Conclusions: In a large population-based cross-sectional study, ED increased considerably with age. There are a range of potentially modifiable risk factors for ED, including smoking, low physical activity, and high body mass index.

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  • Marianne F Weber1
  • David P Smith1
  • Dianne L O'Connell1
  • Manish I Patel2
  • Paul L de Souza3
  • Freddy Sitas1
  • Emily Banks4

  • 1 Cancer Research Division, Cancer Council NSW, Sydney, NSW.
  • 2 Discipline of Surgery, University of Sydney, Westmead, NSW.
  • 3 University of Western Sydney, Sydney, NSW.
  • 4 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT.

Correspondence: mariannew@nswcc.org.au

Acknowledgements: 

We thank the men participating in the 45 and Up Study, which is managed by The Sax Institute in collaboration with major partner Cancer Council New South Wales; and partners the National Heart Foundation of Australia (NSW Division); NSW Ministry of Health; beyondblue: the national depression initiative; Ageing, Disability and Home Care, Department of Family and Community Services NSW; UnitingCare Ageing; and the Australian Red Cross Blood Service.

Competing interests:

Manish Patel has served on advisory boards for Astra Zeneca, Ipsen, Abbott, GSK, Pfizer, Ferring, and Janssen. He has also received royalties from Health Press for fast facts on prostate cancer. Dianne O'Connell has received consultancy fees from the Evaluation Subcommittee of the Medical Services Advisory Committee (Australian Department of Health and Ageing) to provide expert advice on the strength and quality of evidence for medical services, procedures and tests being considered for government subsidisation.

  • 1. Wyllie MG. The underlying pathophysiology and causes of erectile dysfunction. Clin Cornerstone 2005; 7: 19-27.
  • 2. Camacho ME, Reyes-Ortiz CA. Sexual dysfunction in the elderly: age or disease? Int J Impot Res 2005; 17 Suppl 1: S52-S56.
  • 3. Kaminetsky J. Epidemiology and pathophysiology of male sexual dysfunction. Int J Impot Res 2008; 20 Suppl 1: S3-S10.
  • 4. McKinlay JB. The worldwide prevalence and epidemiology of erectile dysfunction. Int J Impot Res 2000; 12 Suppl 4: S6-S11.
  • 5. 45 and Up Study Collaborators, Banks E, Redman S, Jorm L, et al. Cohort profile: the 45 and up study. Int J Epidemiol 2008; 37: 941-947.
  • 6. Mealing NM, Banks E, Jorm LR, et al. Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs. BMC Med Res Methodol 2010; 10: 26.
  • 7. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA 1993; 270: 83-90.
  • 8. Derby CA, Araujo AB, Johannes CB, et al. Measurement of erectile dysfunction in population-based studies: the use of a single question self-assessment in the Massachusetts Male Aging Study. Int J Impot Res 2000; 12: 197-204.
  • 9. Glover J, Tennant S. Remote areas statistical geography in Australia: notes on the Accessibility/Remoteness Index for Australia (ARIA + version). Working Paper Series No. 9. Adelaide: Public Health Information Development Unit, 2003. http://www.publichealth.gov.au/pdf/reports_papers/working_papers_other/wk_ppr9_remoteness_aria+.pdf (accessed Mar 2013).
  • 10. Hays RD, Liu H, Spritzer K, Cella D. Item response theory analyses of physical functioning items in the medical outcomes study. Med Care 2007; 45 (5 Suppl 1): S32-S38.
  • 11. Australian Institute of Health and Welfare. The Active Australia Survey: a guide and manual for implementation, analysis and reporting. Canberra: AIHW, 2003. (AIHW Cat. No. CVD 22.) (accessed Mar 2013).
  • 12. Nicolosi A, Moreira ED Jr, Shirai M, et al. Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction. Urology 2003; 61: 201-206.
  • 13. Smith DP, King MT, Egger S, et al. Quality of life three years after diagnosis of localised prostate cancer: population based cohort study. BMJ 2009; 339: b4817.
  • 14. Baldwin DS. Sexual dysfunction associated with antidepressant drugs. Expert Opin Drug Saf 2004; 3: 457-470.
  • 15. La Vignera S, Condorelli R, Vicari E, et al. Physical activity and erectile dysfunction in middle-aged men. J Androl 2012; 33: 154-161.
  • 16. Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev 2009: (3): CD002759.
  • 17. Tamler R. Diabetes, obesity, and erectile dysfunction. Gend Med 2009; 6 Suppl 1: 4-16.
  • 18. McVary KT, Carrier S, Wessells H; Subcommittee on Smoking and Erectile Dysfunction Socioeconomic Committee, Sexual Medicine Society of North America. Smoking and erectile dysfunction: evidence based analysis. J Urol 2001; 166: 1624-1632.
  • 19. Chapman S. Erectile dysfunction and smoking: subverting tobacco industry images of masculine potency. Tob Control 2006; 15: 73-74.
  • 20. Pourmand G, Alidaee MR, Rasuli S, et al. Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study. BJU Int 2004; 94: 1310-1313.
  • 21. Cheng JY, Ng EM, Chen RY, Ko JS. Alcohol consumption and erectile dysfunction: meta-analysis of population-based studies. Int J Impot Res 2007; 19: 343-352.
  • 22. Bacon CG, Mittleman MA, Kawachi I, et al. A prospective study of risk factors for erectile dysfunction. J Urol 2006; 176: 217-221.
  • 23. Feldman HA, Johannes CB, Derby CA, et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med 2000; 30: 328-338.
  • 24. Holden CA, McLachlan RI, Pitts M, et al. Determinants of male reproductive health disorders: the Men in Australia Telephone Survey (MATeS). BMC Public Health 2010; 10: 96.
  • 25. Baumgartner MK, Hermanns T, Cohen A, et al. Patients' knowledge about risk factors for erectile dysfunction is poor. J Sex Med 2008; 5: 2399-2404.
  • 26. McCullough AR. The penis as a barometer of endothelial health. Rev Urol 2003; 5 Suppl 7: S3-S8.

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