Erectile dysfunction and subsequent substance abuse: a retrospective cohort study of US non-academic hospitals

Erectile dysfunction (ED) affects millions and is associated with cardiovascular disease, diabetes, and depression-conditions that share risk factors with substance use disorders.

This study investigates the temporal relationship between ED diagnosis and subsequent substance abuse/dependence diagnoses across different age groups.

This retrospective cohort study used the TriNetX database to identify adult males from US hospitals with ED diagnoses (ICD-10: N52) with at least 3 years of follow-up. Controls were propensity-matched 1:1 on age and race. Patients were stratified into three age groups (20-39, 40-64, and ≥ 65 years). Cox proportional hazards models assessed risk over a 3-year follow-up period.

Primary outcome was any substance abuse/dependence diagnosis (ICD-10: F10-F19 categories); secondary outcomes examined individual substance categories.

The study included 323 838 patients (161 919 with ED, 161919 controls) across three age strata. In men ≥65 years (n = 176 960), ED was associated with elevated risk for multiple substances. Sedative abuse/dependence showed the strongest association (HR 2.28, 95% CI 1.52-3.42, P < .001), followed by other psychoactive substances (HR 1.79, 95% CI 1.43-2.24), opioids (HR 1.58, 95% CI 1.27-1.95), cocaine (HR 1.60, 95% CI 1.26-2.04), and cannabis (HR 1.45, 95% CI 1.10-1.92) (all P < .05). The elderly cohort showed reduced overall risk (HR 0.86, 95% CI 0.82-0.89, P < .001), driven by protection against nicotine dependence (HR 0.71, 95% CI 0.68-0.75, P < .001). In men 40-64 years (n = 133 292), ED was associated with increased risk for cannabis (HR 1.32, P = .013) and other psychoactive substances (HR 1.21, P = .031), with protective effects for nicotine (HR 0.90, P < .001). Men 20-39 years (n = 13 586) showed protective associations for opioid (HR 0.53, P = .020) and stimulant abuse (HR 0.35, P = .003).

Clinicians should maintain heightened awareness for substance abuse risk, particularly sedative misuse, when evaluating and treating elderly men with ED. Age-specific screening and counseling may be warranted.

Strengths include large sample size and propensity matching. Limitations include potential selection bias, inability to assess treatment adherence, and database-specific coding variations.

Elderly men with ED demonstrate significantly elevated risk for sedative, opioid, and cocaine abuse in the 3 years following ED diagnosis, while younger men show protective associations. These findings suggest a bidirectional relationship that warrants further investigation.