Male Erectile Dysfunction and Health-Related Quality of Life☆
Introduction
Erectile dysfunction (ED) is a serious public health problem affecting millions of citizens and their quality of life [1], [2]. The directly proportional correlation between the age of the subjects and both the probability of suffering erectile dysfunction and its degree of severity is widely documented [3], [4]. As the populations of the Organization for Economic Cooperation Development (OECD) countries are aging but maintaining their interest in sex [5], [6], erectile dysfunction has acquired greater significance as a public health problem, to which the health systems and policies must devote an increasing amount of attention and resources. In the last decade, measurements of health-related quality of life (HRQoL) have gained great relevance in the study of the health status of patients and populations and in the evaluation of both the quality of clinical and health care in general and the efficacy of public health interventions. This has been the result of an historic evolution in the concept of health, which, under the influence of both biomedical and social sciences and of environmental movements, has become more complex and multidimensional [7]. Currently, we are not only concerned with the traditional clinical aspects of the disease—presumably more objective—but also with other more subjective dimensions, in agreement with the definition of health made by the WHO [8], related to the degree of the individual’s physical, social or emotional function, and which considers the satisfaction and well-being of patients in relation to their health as perceived by the individuals themselves. This is known as the health-related quality of life (HRQoL) [9].
This study was made in the context of the EDEM project (Epidemiologı́a de la Disfunción Eréctil Masculina [4], which investigates the prevalence and independent risk factors for Erectile Dysfunction in Spain) and its objective was to establish the HRQoL factors associated with erectile dysfunction.
Section snippets
Design
This is a population-based, prevalence study in which the target population consists of Spanish men aged from 25 to 70 years inclusively, taken from the community at large, who are not institutionalised and who are resident in the Spanish peninsula. A probabilistic, multistage sampling design was used, with stratification of the primary sampling units. The primary sampling units were census section, then secondary sampling units were dwellings and the final sampling units were subjects. The
Results
Participation rate was 75% (n=2476 subjects), and 12.1% (95% CI: 10.8%–13.3%), of men showed some degree of ED: 5.2% mild, 5% moderate and 1.9% severe/complete when simple question is used and 18.9% (95% CI: 17.2%–20.7%) when IIEF instrument is applied to assess ED prevalence. Sociodemographic characteristics were similar between subjects with and without erectile dysfunction. Table 2 shows the age-adjusted odd ratios (ORs) of the different physical and sociodemographic characteristics
Discussion
We found a clear pattern of negative association between self-perceived erectile dysfunction and health-related quality of life, this association being more apparent when ED-sq was used for measuring the degree of EF than when erectile condition was ascertained through the erectile domain of the IIEF. This pattern of negative association is more apparent for the physical summary component of the SF-36 than for the mental one. Although the data strongly suggest that this effect may be different
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The results shown here are part of the EDEM study (J Urol 2001, 166: 569–575), which was supported by an unrestricted grant from Pfizer S.A.