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Authors Weber MF, Smith DP, Patel MI, et al.
Review Date September 2015
Citation MJA 2013; 199: 107-111
Erectile dysfunction (ED) is experienced by about one in five men over the age of 40 years in Australia. ED is associated with medical conditions (e.g. diabetes, stroke), lifestyle factors, medical treatments (e.g. prostate cancer surgery, anti-depressants), and has been recognised as an early indicator of cardiovascular disease. Little is known about the risk factors of ED and their relationship with age in the Australian male population.
To quantify the relationships between ED, ageing, and health and lifestyle factors for men aged 45 years and older.
This paper draws on data from The 45 and Up Study, a cross-sectional, population-based study. Participants were randomly sampled from the Medicare enrolment database and completed a self-report baseline questionnaire between January 2006 and February 2010.
ED was measured with the question, “How often are you able to get and keep an erection that is firm enough for satisfactory sexual activity?” Those who answered ‘always’ or ‘usually’ were categorised as ‘no/minimal ED’ and those who answered ‘sometimes,’ or ‘never’ as ‘moderate/complete ED’ (those who didn’t answer the question were excluded from analysis). Socio-demographic characteristics, selected lifestyle risk factors (smoking status, alcohol consumption, BMI, physical activity), and chronic disease (diabetes, Parkinson disease, stroke, cancer, depression and/or anxiety, blood clotting problems, high blood pressure, arthritis, thyroid problems, asthma, high blood cholesterol level) were also measured.
The study sample was stratified according to disease. The age-related prevalence of moderate/complete ED was calculated among those who reported a disease and those who did not report a disease. Of those who did not report a disease, men were further divided by those who did and did not report lifestyle risk factors. Logistic regression was used to calculate the odds ratio (OR) of having moderate/complete ED for men in each of these groups compared to men who had not been diagnosed with a disease and who did not report lifestyle risk factors. Men with a prostate cancer diagnosis were then excluded from further analyses that calculated the OR for having moderate/complete ED for each socio-demographic variable, included disease, and lifestyle factor.
Of the 123 779 men who completed the questionnaire, 108 477 (88%) were eligible for inclusion in this sub-study. The sample represented a diverse sociodemographic background.
Men who had been diagnosed with prostate cancer were 9.24 times more likely to report moderate/complete ED than those who had not been diagnosed with a disease and who did not report lifestyle risk factors. The majority (85%) of the 6803 men reporting prostate cancer diagnosis reported moderate/compete ED. Men reporting prostate cancer diagnosis were then excluded from the remaining analyses.
Of the remaining 101 674 men, ED status ranged from 39.31% reporting no ED to 16.77% reporting complete ED. Moderate/complete ED was associated with lower socioeconomic status and with being single. The odds of having moderate/complete ED increased by 11% with each year of age.
Men who reported one or more risk factors for ED (e.g. smoking, >30 alcoholic drinks per week) had 26% higher odds of ED than men without risk factors. When looking at each 10 year age strata, ED increased with increasing BMI for all age groups except men aged >75 years. For each age group, increasing levels of physical activity was associated with decreasing odds of ED. When compared to men who had never smoked, those who smoked >20 cigarettes a day were more likely to report moderate/severe ED (OR =1.86) than those who smoked <20 cigarettes per day (OR=1.48). Past smokers had higher odds of moderate/complete ED than those who had never smoked (OR=1.26). For men aged >54 years, the odds of moderate/complete ED were slightly elevated among those who had consumed >30 drinks in the past week (OR not stated).
All diseases measured were significantly associated with ED except high blood cholesterol level. The highest odds of moderate/complete ED were for diabetes (OR=2.66) and being treated for depression and/or anxiety in the last month (OR=2.36).
This study provided a comprehensive report of the prevalence of ED and associated risk factors across men of different ages. Clinicians may wish to advise male patients of the potential for ED to be a complication of various diseases due to the underlying vasculogenic mechanisms and of the risks associated with engaging in lifestyle behaviours such as smoking and not being engaged in physical activity.
Points to Note
- ED is a prevalent condition among men in Australia but little is known about the associated risk factors and how they interact with men’s age.
- The findings of this study are similar to those conducted internationally, including that the odds of ED increase by 11% per year from the age of 45.
- Men who reported one or more risk factors for ED (e.g. smoking, >30 alcoholic drinks per week) had 26% higher odds of ED than men without risk factors.
- Of all the diseases measured, diabetes and recent treatment for depression and/or anxiety were most highly associated with moderate/complete ED.
- The limitations of this study include an inability to assign cause and effect due to the cross-sectional design, the possibility that the prevalence reported may not be generalisable to the population as the participation rate was low (18%), and the potential for recall bias given the use of self-report. (Note, Andrology Australia has published population-based ED prevalence estimates for men aged 40 years and older, from the Men in Australia Telephone Survey: Holden et al, Lancet 2005).