Department of Maternal-Infant and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy; Department of Urology, Stanford University School of Medicine, Stanford, CA.
Department of Urology, Stanford University School of Medicine, Stanford, CA.
Urology. 2021 Jan;147:143-149. doi: 10.1016/j.urology.2020.07.087. Epub 2020 Oct 2.
To determine whether male infertility or impaired spermatogenesis is associated with mortality.
The Optum de-identified Clinformatics Data Mart database was queried from 2003 to 2017. Infertile men were compared to subjects undergoing semen analysis (ie, infertility testing). Infertile men with oligozoospermia or azoospermia were included. Mortality was determined by data linkage to the Social Security Administration Death Master File. Results were adjusted for age, smoking, obesity, year of evaluation, and health care visits as well as for most prevalent comorbidities. We separately examined men with prevalent or incident cardiovascular disease and cancer diagnoses to determine associations with mortality.
A total of 134,796 infertile men and 242,282 controls were followed for a mean of 3.6 and 3.1 years respectively. Overall, infertile men had a higher risk of death (Hazard Ratio [HR]= 1.42, 95% CI: 1.27-1.60) The diagnosis of azoospermia was associated with a significantly increased risk of death (HR= 2.01, 95% CI: 1.60-2.53) with a higher trend among men with oligospermia (HR: 1.17, 95% CI: 0.92-1.49) compared to controls. Subanalysis was done excluding prevalent cardiovascular and malignant disease (alone and combined) showing similar hazard ratios.
Male infertility is associated with a higher risk of mortality especially among azoospermic men. Prevalent disease (which is known to be higher among infertile men) did not explain the higher risk of death among infertile men. The implications for treatment and surveillance of infertile men require further study.
确定男性不育或生精障碍是否与死亡率相关。
从 2003 年到 2017 年，查询 Optum 去识别 Clinformatics 数据集市数据库。将不育男性与接受精液分析（即不育检查）的受试者进行比较。纳入少精子症或无精子症的不育男性。通过与社会保障管理局死亡主文件的数据链接确定死亡率。结果通过年龄、吸烟、肥胖、评估年份和就诊次数以及最常见的合并症进行调整。我们分别检查了患有现患或新发心血管疾病和癌症诊断的男性，以确定与死亡率的关联。
共随访了 134796 名不育男性和 242282 名对照者，平均随访时间分别为 3.6 年和 3.1 年。总体而言，不育男性的死亡风险较高（风险比[HR]=1.42，95%可信区间：1.27-1.60）。无精子症的诊断与死亡风险显著增加相关（HR=2.01，95%可信区间：1.60-2.53），少精子症男性的趋势更高（HR：1.17，95%可信区间：0.92-1.49）与对照组相比。排除现患心血管和恶性疾病（单独和联合）的亚分析显示出相似的危险比。
男性不育与死亡率升高相关，尤其是在无精子症男性中。已知在不育男性中更为常见的现患疾病并不能解释不育男性死亡风险较高的原因。需要进一步研究对不育男性的治疗和监测的影响。
