Mulloy Evan, Zhang Amy, Balladelli Federico, Del Giudice Francesco, Glover Frank, Eisenberg Michael L
Department of Urology, Stanford University School of Medicine, Palo Alto, CA, United States.
Division of Experimental Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.
Sex Med. 2023 Aug 2;11(4):qfad040. doi: 10.1093/sexmed/qfad040. eCollection 2023 Aug.
Delayed ejaculation (DE) is a disorder that can cause significant distress for sexually active men. The etiology of DE is largely idiopathic, with even less being known about clinical factors associated with the condition.
We sought to use data mining techniques to examine a broad group of health conditions and pharmaceutical treatments to identify factors associated with DE.
Using an insurance claims database, we evaluated all men with a diagnosis of DE and matched them to a cohort (1:1) of men with other male sexual disorders of urologic origin (ie, erectile dysfunction [ED] and Peyronie's disease [PD]). Given the low prevalence of DE, we incorporated the random forest approach for classification of DE vs controls, with a plethora of predictors and cross-validation with the least absolute shrinkage and selection operator (LASSO). We used both a high-performance generalized linear model and a multivariate logistic model. The area under the curve was reported to demonstrate classifier performance, and odds ratios were used to indicate risks of each predictor. We also evaluated for differences in the prevalence of conditions in DE by race/ethnicity.
Clinical factors (ie, diagnoses and medications) associated with DE were identified.
In total, 11 602 men with DE were matched to a cohort of men with PD and ED. We focused on the 20 factors with the strongest association with DE across all models. The factors demonstrating positive associations with DE compared to other disorders of male sexual dysfunction (ie, ED and PD) included male infertility, testicular dysfunction, anxiety, disorders of lipid metabolism, alpha adrenergic blocker use, anemia, antidepressant use, and psychoses such as schizophrenia or schizoaffective disorder. In addition, the prevalence of several conditions varied by race/ethnicity. For example, male infertility was present in 5% of Asian men compared to <2% of men of other races.
Several medical conditions and pharmacologic treatments are associated with DE, findings that may provide insight into the etiology of DE and offer treatment options.
This study is to our knowledge the first to use using data mining techniques to investigate the association between medical conditions/pharmacologic agents and the development of subsequent DE. The generalizability of our findings is limited given that all men were commercially insured.
DE is associated with multiple medical conditions, a finding that may help identify the etiology for this disorder.
射精延迟（DE）是一种会给性活跃男性带来极大困扰的疾病。DE的病因大多不明，对于与之相关的临床因素更是知之甚少。
我们试图运用数据挖掘技术，研究广泛的健康状况和药物治疗方法，以确定与DE相关的因素。
利用保险理赔数据库，我们评估了所有被诊断为DE的男性，并将他们与一组患有其他泌尿生殖系统起源的男性性功能障碍（即勃起功能障碍[ED]和佩罗尼氏病[PD]）的男性进行匹配（1:1）。鉴于DE的患病率较低，我们采用随机森林方法对DE与对照组进行分类，使用大量预测变量，并采用最小绝对收缩和选择算子（LASSO）进行交叉验证。我们使用了高性能广义线性模型和多变量逻辑模型。报告曲线下面积以展示分类器性能，并使用优势比来表明每个预测变量的风险。我们还评估了不同种族/族裔中DE患者疾病患病率的差异。
确定了与DE相关的临床因素（即诊断和药物）。
总共11602名患有DE的男性与一组患有PD和ED的男性进行了匹配。我们关注了所有模型中与DE关联最强的20个因素。与其他男性性功能障碍（即ED和PD）相比，与DE呈正相关的因素包括男性不育、睾丸功能障碍、焦虑、脂质代谢紊乱、使用α肾上腺素能阻滞剂、贫血、使用抗抑郁药以及精神疾病如精神分裂症或分裂情感障碍。此外，几种疾病的患病率因种族/族裔而异。例如，5%的亚洲男性患有男性不育，而其他种族男性的这一比例不到2%。
几种疾病状况和药物治疗与DE相关，这些发现可能有助于深入了解DE的病因并提供治疗选择。
据我们所知，本研究是首次使用数据挖掘技术来研究疾病状况/药物与随后发生的DE之间的关联。鉴于所有男性均为商业保险，我们研究结果的普遍性有限。
DE与多种疾病状况相关联，这一发现可能有助于确定该疾病的病因。
