Increasing age, diabetes, high body mass index, and current smoking are among the risk factors for erectile dysfunction (ED), according to a large study of men living in New South Wales (NSW), Australia.

The study, published in the Medical Journal of Australia (2013;199:107-111), “confirms the importance of a number of risk factors for ED that are potentially modifiable, and that may be associated with other longer lasting health benefits,” researchers concluded.

Marianne F. Weber, PhD, of Cancer Council NSW in Sydney, and colleagues studied 101,674 men aged 45 years and older who had reported no prior diagnosis of prostate cancer. Of these, 39.3% had no ED, 25.1% had mild ED (experienced ED sometimes), 18.79% had moderate ED (usually experienced ED), and 16.8% had complete ED.

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After adjusting for sociodemographic characteristics, the odds of moderate/complete ED increased significantly by 11.3% each year beginning at age 45. The prevalence of moderate/complete ED was 82% among men aged 75 and older.

In a fully adjusted model, diabetes was associated with a significant 2.4 times increased odds of moderate/complete ED compared with the absence of diabetes.

Compared with normal-weight men (body mass index [BMI] of at least 18.5 but less than 25 kg/m2), obese men with a BMI of at least 35 but less than 40 and those with a BMI of 40 or higher had a 2.2 times and 3.2 times increased risk, respectively. The risk of moderate/complete ED increased with increasing BMI for all age groups except for men aged 75 and older.

Subjects who smoked 20 or more cigarettes per day had a significant 86% increased risk of moderate/complete ED compared with men who never smoked. Past smokers had a 26% increased risk compared with those who never smoked.

Additionally, patients treated for depression or anxiety or both in the past month had a significant twofold increased risk of moderate or complete ED than those who were not.

Moderate alcohol consumption was associated with a significantly reduced risk of ED among men aged 45-54 years, but not older men, according to the investigators.

The study also found that low educational attainment and low household income was associated with increased odds of moderate/complete ED. Compared with men who had a university degree or higher, those who no educational qualifications had a significant 56% increased odds. Compared with men whose pretax annual household income was at least $50,000, those whose income was $20,000-$49,999 and $19,000 or less had a 39% and 85% increased odds of moderate/complete ED, respectively.

“This report provides a comprehensive picture of how the prevalence of ED and its risk factors differ across men of different ages and is by far the largest analysis of ED to date,” the authors wrote.