Mulhall John P, Luo Xuemei, Zou Kelly H, Stecher Vera, Galaznik Aaron
Memorial Sloan Kettering Cancer Center Urology Service, Department of Surgery, New York, NY, USA.
Pfizer Inc, New York, NY, USA.
Int J Clin Pract. 2016 Dec;70(12):1012-1018. doi: 10.1111/ijcp.12908.
With self-reporting of erectile dysfunction (ED) in population-based surveys, men with ED may not represent men who are bothered sufficiently to seek an ED diagnosis and treatment. We used real-world observational data to assess: 1) the prevalence of ED diagnosis or treatment by age subgroups; and 2) the relationship of age with ED diagnosis or treatment after controlling for ED-related comorbidities in the USA.
This cross-sectional study used de-identified claims data (MarketScan databases; primary analysis). Sensitivity analysis was conducted using electronic health records (Humedica database). Inclusion criteria were men aged ≥18 years with a 360-day continuous enrollment before the index date. We assessed the prevalence of ED diagnosis or phosphodiesterase type 5 inhibitor (PDE5I) prescription by age and the risk for ED diagnosis or treatment by age after controlling for comorbidities (hypertension, other cardiovascular disease, diabetes mellitus, depression and benign prostatic hyperplasia).
Of 19,833,939 men meeting inclusion criteria in the primary analysis, only 1 108 842 (5.6%) had an ED diagnosis or PDE5I prescription (mean [SD] age: 55.2 [11.2] years). Prevalence of ED diagnosis or treatment increased from age 18-29 years (0.4%) to 60-69 years (11.5%), then decreased in the seventh (11.0%), eighth (4.6%), and ninth (0.9%) decades. Men with ED diagnosis or treatment had a higher prevalence of any comorbidity (63.1% vs 29.3% for men without ED) and of each comorbid condition. In multivariate analyses, age was an independent risk factor for ED diagnosis or treatment. Sensitivity analysis provided consistent results.
In a real-world setting in the USA, the prevalence of ED diagnosis or PDE5I treatment is generally low, increases with age, decreases in very old men, and is associated with increased prevalence of comorbidities. Age is an independent risk factor for ED diagnosis or treatment after controlling for comorbidities.
在基于人群的调查中，通过自我报告勃起功能障碍（ED），患有ED的男性可能并不代表那些因受困扰而充分寻求ED诊断和治疗的男性。我们使用真实世界的观察数据来评估：1）按年龄亚组划分的ED诊断或治疗的患病率；2）在美国，在控制了与ED相关的合并症后，年龄与ED诊断或治疗之间的关系。
这项横断面研究使用了去识别化的索赔数据（MarketScan数据库；主要分析）。使用电子健康记录（Humedica数据库）进行敏感性分析。纳入标准为年龄≥18岁且在索引日期前连续参保360天的男性。我们评估了按年龄划分的ED诊断或5型磷酸二酯酶抑制剂（PDE5I）处方的患病率，以及在控制合并症（高血压、其他心血管疾病、糖尿病、抑郁症和良性前列腺增生）后按年龄划分的ED诊断或治疗的风险。
在主要分析中符合纳入标准的19833939名男性中，只有1108842名（5.6%）有ED诊断或PDE5I处方（平均[标准差]年龄：55.2[11.2]岁）。ED诊断或治疗的患病率从18 - 29岁（0.4%）增加到60 - 69岁（11.5%），然后在第七个十年（11.0%）、第八个十年（4.6%）和第九个十年（0.9%）有所下降。有ED诊断或治疗的男性任何合并症的患病率更高（有ED的男性为63.1%，无ED的男性为29.3%），且每种合并症的患病率也更高。在多变量分析中，年龄是ED诊断或治疗的独立危险因素。敏感性分析提供了一致的结果。
在美国的真实世界环境中，ED诊断或PDE5I治疗的患病率普遍较低，随年龄增加，在非常老年的男性中有所下降，并且与合并症患病率增加相关。在控制合并症后，年龄是ED诊断或治疗的独立危险因素。
