Risk of Erectile Dysfunction After Traumatic Brain Injury: A Nationwide Population-Based Cohort study in Taiwan

Abstract

Introduction:In our study, we aimed to investigate the association between a traumatic brain injury (TBI) and subsequent erectile dysfunction (ED). This is a population-based study using the claims dataset from The National Health Insurance Research Database.Methods:We included 72,642 patients with TBI aged over 20 years, retrospectively, selected from the longitudinal health insurance database during 2000–2010, according to the ICD-9-CM. The control group consisted of 217,872 patients without TBI that were randomly chosen from the database at a ratio of 1:3, with age- and index year matched. Cox proportional hazards analysis was used to estimate the association between the TBI and subsequent ED.Results:After a 10-year follow-up, the incidence rate of ED was higher in the TBI patients when compared with the non-TBI control group (24.66 and 19.07 per 100,000, respectively). Patients with TBI had a higher risk of developing ED than the non-TBI cohort after the adjustment of the confounding factors, such as age, comorbidity, residence of urbanization and locations, seasons, level of care, and insured premiums (adjusted hazard ratio (HR) = 2.569, 95% CI [1.890, 3.492], p < .001).Conclusion:This is the first study using a comprehensive nationwide database to analyze the association of ED and TBI in the Asian population. After adjusted the confounding factors, patients with TBI have a significantly higher risk of developing ED, especially organic ED, than the general population. This finding might remind clinicians that it’s crucial in early identification and treatment of ED in post-TBI patients.

Association of Concussion Symptoms With Testosterone Levels and Erectile Dysfunction in Former Professional US-Style Football Players

“…Our findings add to a literature composed of studies linking single head injuries with pituitary dysfunction in the general population, 6 , 9 , 10 , 11 small studies of professional boxers, 23 , 24 , 25 , 26 , 62 , 63 and findings from veterans with blast-induced head injury, 27 , 28 , 29 indicating that mechanical and blast-induced trauma may have associations with pituitary and sexual function. To our knowledge, this is the first large study to examine low testosterone levels and ED, albeit indirectly, in a nonclinical population with a high prevalence of repeated injuries.…”

“… 6 Over a 10-year follow-up, the adjusted hazard ratio for ED in patients with TBI was 2.5 compared with participants without injuries, and greater TBI severity was associated with higher risk of ED. 6 However, this study focused only on medically evaluated single head injuries, rendering results less applicable to often underdiagnosed sports-related head traumas. 20 , 21 Furthermore, this study did not evaluate dose-response associations with repeated head injuries and lacked covariate data, such as body mass index (BMI; calculated as weight in kilograms divided by height in meters squared).…”

“…Studies on sexual function in participants with brain injuries have reported a reduced frequency of intercourse, 10 , 12 , 13 , 14 diminished libido, 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 impaired ability to orgasm, 10 , 12 , 13 , 18 , 19 ED, 6 , 10 , 13 , 14 , 15 , 17 and sexual arousal issues. 10 , 12 , 18 However, these studies were conducted in clinical settings, 6 , 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 many were small (N < 100) 9 , 13 , 14 , 15 , 17 , 19 or did not specifically investigate ED. 12 , 16 , 18 , 19 Only 1 large study examined ED subsequent to a single TBI in 73 000 clinical patients and 218 000 controls.…”

Psychiatric Disorders in Female Psychosexual Disorders—A Nationwide, Cohort Study in Taiwan

“…The records of ambulatory care visits and inpatient claims periodically were reviewed randomly by the National Health Insurance (NHI) Administration to verify the accuracy of the diagnoses [11]. Several previous studies have documented the details of the program [12][13][14][15][16].…”

“…The present study has several limitations that warrant consideration. First, similar to previous studies using the NHIRD on psychosexual disorders [15,[48][49][50], we were unable to evaluate the severity, weakness severity, laboratory parameters, or psychological assessments in the PSD patients, since the data were not recorded in the NHIRD. Second, the genetic, psychosocial, and environmental factors, were not included in the dataset.…”