title: Relationship between age and erectile dysfunction diagnosis or treatment using real-world observational data in the USA.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Memorial Sloan Kettering Cancer Center Urology Service, Department of Surgery, New York, NY, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Mulhall
authors.affiliation: Pfizer Inc, New York, NY, USA.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Luo
authors.affiliation: Pfizer Inc, New York, NY, USA.
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Zou
authors.affiliation: Pfizer Inc, New York, NY, USA.
authors.forename: Vera
authors.initials: V
authors.lastname: Stecher
authors.affiliation: Pfizer Inc, New York, NY, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Galaznik
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D007172:Erectile Dysfunction / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D011470:Prostatic Hyperplasia / Q000453:epidemiology; D012307:Risk Factors; D055815:Young Adult
chemical_list: D058986:Phosphodiesterase 5 Inhibitors
keywords: age groups; comorbidity; electronic health records; erectile dysfunction; observational study; phosphodiesterase type 5 inhibitors; real-world claims data