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Association of erectile dysfunction with all-cause and cardiovascular mortality in US men: findings from NHANES 2001–2004 with 16-year follow-up

International Journal of Impotence Research (2025)Cite this article

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Abstract

Erectile dysfunction (ED) is a common condition in men; however, evidence of its association with mortality is limited. We examined the association between ED and long-term all-cause and cardiovascular (CV) mortality in a nationally representative cohort of adult men. This prospective cohort study included data from men aged 20 years and older from the 2001–2004 National Health and Nutrition Examination Survey linked to National Death Index records through December 31, 2019. ED was defined as reporting sometimes or never being able to achieve or maintain an erection adequate for satisfactory intercourse. Primary outcomes were the associations of ED with all-cause and  CV mortality, evaluated using survey-weighted Cox proportional hazards regression models. Among 4 110 men followed for a median of 16.3 years, 1 226 deaths (419 CV deaths) occurred. In fully adjusted models, ED was independently associated with an increased risk of all-cause (HR, 1.45; 95% CI, 1.20–1.75) and CV (HR, 1.57; 95% CI, 1.12–2.19) mortality. The magnitude of these associations was similar to those observed for other CV risk factors such as diabetes mellitus, hypertension, and stroke. These findings suggest the need to broaden clinical perspectives on ED beyond sexual health to recognize its significance as a marker of mortality risk.

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Fig. 1: Selection of analytic sample from NHANES 2001–2004 participants.
Fig. 2: Association of erectile dysfunction with all-cause and cardiovascular mortality in US men aged 20 years and older.
Fig. 3: Adjusted cumulative incidence of all-cause mortality by erectile dysfunction status.
Fig. 4: Adjusted cumulative incidence of cardiovascular mortality by erectile dysfunction status.

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Data availability

The data from this study will not be shared. Data from the 2001–2004 National Health and Nutrition Examination Survey (https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?BeginYear=2001; https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?BeginYear=2003) and National Death Index records through December 31, 2019 (https://www.cdc.gov/nchs/linked-data/mortality-files/index.html) are publicly available.

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Funding

Boston Scientific supported this study. The sponsor was involved in the study design, interpretation of the data, review and approval of the manuscript, and decision to submit the manuscript for publication. The sponsor was not involved in the analysis of the data or drafting of the manuscript.

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Authors and Affiliations

  1. Health Economics and Market Access, Boston Scientific, Marlborough, MA, USA

    Samir Bhattacharyya & Siri Rojanasarot

  2. Department of Biostatistics, Miller Scientific, Johnson City, TN, USA

    Larry E. Miller

  3. Department of Urology, University of California San Diego, La Jolla, San Diego, CA, USA

    Darshan P. Patel

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  1. Samir Bhattacharyya
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Contributions

L.M. conducted the analysis and drafted the manuscript. S.B., S.R., and D.P. critically reviewed and edited the manuscript. S.B. supervised the project administration. All authors reviewed and approved the final version of the manuscript. L.M. had primary responsibility for the final content.

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Correspondence to Larry E. Miller.

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Competing interests

S.B. and S.R. report employment with Boston Scientific. L.M. reports consultancy with Boston Scientific. D.P. reports receiving a grant from the Biomedical Laboratory Research & Development Service (BLRD) of the US Department of Veterans Affairs, unrelated to this work.

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Bhattacharyya, S., Miller, L.E., Rojanasarot, S. et al. Association of erectile dysfunction with all-cause and cardiovascular mortality in US men: findings from NHANES 2001–2004 with 16-year follow-up. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01218-z

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