Socioeconomic Status, Not Race/Ethnicity, Contributes to Variation in the Prevalence of Erectile Dysfunction: Results from the Boston Area Community Health (BACH) Survey

INTRODUCTION: Few population-based studies have assessed variations in the burden of erectile dysfunction (ED) by race/ethnicity. AIM: To estimate prevalence rates of ED by race/ethnicity and determine the contribution of behavioral risk factors, chronic illnesses, and socioeconomic factors to potential race/ethnic differences in ED. METHODS: The Boston Area Community Health (BACH) Survey is a study of urologic symptoms in a racially and ethnically diverse population. BACH used a multistage stratified random sample to recruit 2,301 men aged 30-79 years from the city of Boston. Self-reported race/ethnicity was defined as Black, Hispanic, and White. Socioeconomic status (SES) was defined as a combination of education and household income. MAIN OUTCOME MEASURES: ED assessed using the 5-item International Index of Erectile Function (IIEF-5). IIEF-5 scores were used both as a continuous variable and dichotomized as /=17. RESULTS: Overall prevalence of ED (defined as an IIEF-5 score </=16) was 20.7% with higher prevalence observed among both Black men (24.9%) and Hispanic men (25.3%) compared to White men (18.1%). Increased odds of ED were observed for both Black and Hispanic men after adjusting for age, comorbid conditions (cardiovascular disease, diabetes, depression), and behavioral risk factors (smoking, physical activity, alcohol use). After controlling for the effect of SES, the association between race/ethnicity and ED disappeared. In contrast, men in the low SES category had an over two-fold increase in risk of ED (adjusted odds ratio of 2.26, 95% confidence interval 1.39, 3.66). CONCLUSIONS: The increased risk of ED in Black and Hispanic men is associated with differences in SES rather than differences in known risk factors of ED.