The association of erectile dysfunction with productivity and absenteeism in eight countries globally

Abstract

Aim:To evaluate the association of erectile dysfunction (ED) with work productivity loss, activity impairment and health-related quality of life (HRQoL) across Brazil, China, France, Germany, Italy, Spain, the UK and the US. Methods:This cross-sectional observational study used data from adult men (40-70 years old; N = 52 697) from the 2015 and 2016 National Health and Wellness Surveys. ED assessment was based on self-reported difficulty in achieving or maintaining an erection in the past 6 months. Impairment to work and non-work activities and HRQoL were assessed for each country and compared against the US. Multivariable models tested interactions between ED status and country for each outcome. Results:Overall ED prevalence was reported as 49.7%, with Italy reporting the highest rate (54.7%). Men with ED reported significantly higher absenteeism (7.1% vs 3.2%), presenteeism (22.5% vs 10.1%), overall work productivity impairment (24.8% vs 11.2%), activity impairment (28.6% vs 14.5%) and significantly lower Mental Component Summary scores (MCS; 46.7 vs 51.2), Physical Component Summary scores (PCS; 48.3 vs 53.0), and health state utilities (SF-6D: 0.693 vs 0.778; all, P < 0.001) than men with no ED. After adjusting for covariates, compared with the US, the association of ED status with overall work productivity impairment was greatest in the UK (26% higher; P < 0.05), and with MCS, PCS and SF-6D scores was greatest in China (−2.67, −1.58, and −0.043 points, respectively; all, P < 0.001). Greater ED severity was significantly associated with higher impairment to work and non-work activities and lower HRQoL, with China reporting the highest burden, compared with the US (most P < 0.05).Conclusion: ED poses a significant burden with respect to work productivity and HRQoL, with greater severity associated with worse outcomes. Better management and earlier detection may help reduce this burden, especially in countries reporting a strong association between ED and poor economic and health outcomes. | INTRODUC TI ONErectile dysfunction (ED) is defined as the persistent inability to achieve and/or maintain penile erection sufficient for performing sexual intercourse. 1 ED can be caused by endocrine (reduced serum testosterone levels), non-endocrine (arterial inflow disorders and abnormalities of venous outflow), neurogenic (affecting innervation and nervous function) and iatrogenic (relating to a medical or surgical treatment) factors. 2 An extrapolation of the Massachusetts Male Aging Study, whichreported an ED prevalence of 52% in men aged 40-70 years, suggested that global ED prevalence will increase from 152 million

Addressing Health-Care System Inequities in the Management of Erectile Dysfunction: A Call to Action

“…Employersponsored insurers with a ben efit exclusion for ED treatment undercut the determination of medically necessary treatment made by licensed med ical professionals and the medical policies developed and published by the health insurance companies that administer their benefits. The exclusions for ED treat ment ultimately negatively affect employers as they have implications for employee satisfaction and retention (Fabius et al, 2013;Goetzel et al, 2016;Goldstein, Goren, Li, Maculaitis, et al, 2019;Grossmeier et al, 2016). Policy wording that facilitates healthcare provid ers' implementation of treatment guidelines supports gender equity for reproductive health care by enabling access to medically necessary ED treatment.…”

“…Evidence has reported that a healthy and engaged work force correlates with exceptional company financial performance (Fabius et al, 2013;Goetzel et al, 2016;Grossmeier et al, 2016). Allowing access to medically necessary health benefits such as ED treatment could benefit employers through increased productivity, loy alty, and retention as well as decreased absenteeism and presentism rates (Fabius et al, 2013;Goetzel et al, 2016;Goldstein, Goren, Li, Maculaitis, et al, 2019;Grossmeier et al, 2016).…”

“…ED poses a considerable burden with profound psychological consequences as it may interfere with a man’s overall quality of life (QoL), including but not limited to well-being, self-esteem, relationships, and self-worth—not only personally but also in the workplace (Goldstein, Goren, Li, Maculaitis, et al, 2019). Sexuality is an integral part of an individual’s well-being and QoL.…”

“…The Impotence Association (now the Sexual Dysfunction Association) reported that 62% of participants in their online survey felt that ED reduced their self-esteem; 29% said their relationships had been affected; and 21% reported that their relationship had ended as a direct consequence (The Impotence Association [now the Sexual Dysfunction Association], 1997). Men with ED have significantly lower Short-Form 36 (SF-36) Mental Component Summary scores (MCS; 46.7 vs. 51.2), Physical Component Summary scores (PCS; 48.3 vs. 53.0), and health state utilities (Short-Form 6 [SF-6D]: 0.693 vs. 0.778; all p < .001) compared to men without ED (Goldstein, Goren, Li, Maculaitis, et al, 2019). Workplace productivity impairment and absenteeism is prevalent in men with ED.…”

“…Workplace productivity impairment and absenteeism is prevalent in men with ED. Men with ED have signifi cantly higher rates of absenteeism, presenteeism, overall work productivity impairment, and activity impairment compared to men without ED (Goldstein, Goren, Li, Maculaitis, et al, 2019). It is therefore important to ensure that all types of effective ED treatments are con sistently accessible to patients with documented medical necessity.…”