Exploring the relationship between social determinants of health and erectile dysfunction using the NHANES survey

Erectile dysfunction (ED) is a prevalent health issue that significantly impacts men’s sexual health and may be related to social factors. This study aims to examine the association between social determinants of health (SDoH) and ED in American men. This cross-sectional study used data from the National Health and Nutrition Examination Survey 2003 to 2004, including 1858 men aged ≥20 years. Each unfavorable SDoH was assigned a score of 1, including unemployment, low income, food insecurity, low education levels, lack of healthcare access, lack of health insurance, housing instability, and not being married or living with a partner. ED status was defined by self-reported erectile function. Multivariable logistic regression models assessed the associations of SDoH scores with ED. Restricted cubic spline was used to identify the dose–response relationship. Cumulative SDoH scores were associated with ED status (odds ratio [OR] = 1.19, 95% CI: 1.03–1.37). This relationship was nonlinear, with a cutoff value of 2 ( P overall < 0.001, P nonlinear = 0.046). Unemployment (OR = 1.59, 95% confidence interval [CI]: 1.08–2.33), a family income-to-poverty ratio < 300% (OR = 1.60, 95% CI: 1.19–2.16), and education level below high school (OR = 1.75, 95% CI: 1.05–2.91) were independently associated with ED status. Individuals with unfavorable SDoH, particularly those who are unemployed, have low income, and low education levels, are at higher risk for ED.