Erectile Dysfunction Rates in US Military Double Over 10 Years

Erectile dysfunction has more than doubled in male U.S. service members over the past decade, according to a report by the Armed Service Health Surveillance Center.

During a 10-year surveillance period, there were 100,248 incident cases of ED in active component servicemen -- that's an average rate of 8.4 per 1,000 person-years.

Researchers often use "person-years" as a metric for epidemiological studies in which a person-year is the measure of the number of years that individuals of a given population have been affected by a condition. Since the number of people in the military changes each year, it's easier to measure.

"Crude incidence rates of ED more than doubled during the surveillance period from 5.8 cases per 1,000 p-yrs in 2004 to 12.6 cases per 1,000 p-yrs in 2013," the report states.

ED is defined as the persistent inability to achieve and sustain an erection that is adequate for sexual intercourse. Advancing age is the primary risk factor for ED. Other risk factors include obesity, smoking and chronic health conditions diabetes, cardiovascular disease, and mental health disorders such as depression, post-traumatic stress disorder.

Between 2004 and 2013, ED was newly diagnosed, on average, in approximately 10,000 active component servicemen per year. 

The Army had 48,445 cases and an incident rate of 10.9. The Navy had 20,281 and an incident rate of 7.3. The Air Force had 20,805 cases and an incident rate of 7.8 and the Marine Corps had 7,822 cases and an incident rate of 4.4. The Coast Guard had 2,895 cases and an incident rate of 8.3, according to the report.

As expected, incidence rates were higher in the older age groups and the highest rates were observed in those aged 60 years or older. The incidence rates were sharply higher in service members aged 40 years or older.

Separated, divorced, and widowed servicemen had an almost four-fold higher crude incidence rate of ED than servicemen who had never married.

For the entire period, black, non-Hispanic servicemen had higher crude incidence rates of ED compared to servicemen of other race/ethnicity groups. Black males had an incident rate of 15 out of 25,687 cases -- that's double to white service members who had a rate of 7 out of 54,790 cases, the report states.

This finding is consistent with other published literature and mirrors findings in civilian populations, the report states.

"A cross-sectional study examining ED prevalence rates by race and ethnicity in U.S. civilian men aged 40 years or older reported the highest prevalence rates in blacks," according to the report. "Additionally, black, non-Hispanic service members have higher incidence rates of several conditions known to be risk factors for ED (i.e., hypertension, obesity, and diabetes.)"

Some findings, however, differ from those seen in the civilian literature. In other studies, "lower levels of education were associated with higher ED prevalence while the results in this study indicated that those with higher levels of education were more likely to be diagnosed with ED," the study states.

There was one finding that stood out in the report. Over the entire period, servicemen who had never deployed had the highest crude incidence rates of ED -- 10.1 per 1,000 person-years.

The findings of this report should be considered in light of some significant limitations. For example, incident cases of ED were ascertained from ICD-9 coded diagnoses in the administrative medical records.

This means that a serviceman would have to have sought medical care for ED to be counted as a case in this analysis. Therefore, the numbers in this report likely underestimated the true incidence of ED in this population as not all servicemen with the condition seek or receive medical care for it, according to the report.

This point is especially relevant with regard to any comparison of the numbers and rates of ED in this study to rates of ED in the medical literature because most studies use other sources of data such as questionnaires and surveys, the report states.

In addition, the counts and rates presented in this report are a result of electronic review of the medical records for diagnoses of ED among all servicemen, allowing a truly population-level estimate. This approach contrasts with studies in the published literature that often rely on relatively small samples to derive estimates of ED prevalence.

-- Matthew Cox can be reached at Matthew.Cox@military.com.