Human Papillomavirus Infection and the Risk of Erectile Dysfunction: A Nationwide Population-Based Matched Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Population
2.3. Definitions of the Outcomes and Covariates
2.4. Negative Control Exposure
2.5. Statistical Analysis
2.6. Sensitivity Analyses
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Non-HPV | HPV | SMD | ||
---|---|---|---|---|---|
(N = 53,184) | (N = 13,296) | ||||
n | % | n | % | ||
Age, year | |||||
18–30 | 19,768 | 37% | 4895 | 37% | 0.007 |
31–40 | 10,967 | 21% | 2710 | 20% | 0.006 |
41–50 | 9873 | 19% | 2399 | 18% | 0.01 |
≥51 | 12,576 | 24% | 3292 | 25% | 0.03 |
mean, (SD) | 39.0 | (15.7) | 39.4 | (16.3) | 0.03 |
Comorbidities | |||||
hypertension | 9821 | 18% | 2492 | 19% | 0.007 |
diabetes mellitus | 4398 | 8.0% | 1190 | 9.0% | 0.02 |
hyperlipidemia | 9419 | 18% | 2458 | 18% | 0.02 |
Stroke | 2243 | 4.0% | 654 | 5.0% | 0.03 |
CAD | 640 | 1.0% | 217 | 2.0% | 0.04 |
CKD | 548 | 1.0% | 187 | 1.0% | 0.03 |
COPD | 4987 | 9% | 1351 | 10% | 0.03 |
Alcohol-related illness | 1838 | 3.0% | 481 | 4.0% | 0.009 |
HIV | 80 | 0.0% | 32 | 0.0% | 0.02 |
AID | 754 | 1.0% | 238 | 2.0% | 0.03 |
Medication | |||||
α-blocker | 7283 | 14% | 1909 | 14% | 0.02 |
β-blocker | 3776 | 7% | 1017 | 8% | 0.02 |
CCB | 9842 | 19% | 2472 | 19% | 0.002 |
diuretics | 6470 | 12% | 1673 | 13% | 0.01 |
Hazard Ratio (95% CI) | |
---|---|
Primary analysis | |
Model 1 (adjusted comorbidities + comedications) | 1.64 (1.38, 1.95) *** |
Model 2 (adjusted comorbidities + comedications + relevant operation) | 1.63 (1.37, 1.94) *** |
Sensitivity analyses | |
HPV excluding stroke, cancer, AID | 1.59 (1.30, 1.95) *** |
Alternative exposure (NTS) | 0.69 (0.31, 1.53) |
Variables | Erectile Dysfunction | (95% CI) | |||||
---|---|---|---|---|---|---|---|
n | PY | IR | cHR | (95% CI) | aHR ꝉ | ||
non-HPV | 432 | 286,137 | 1.51 | 1.00 | - | 1.00 | - |
HPV | 181 | 71,478 | 2.53 | 1.69 | (1.42, 2.00) *** | 1.63 | (1.37, 1.94) *** |
Age, year | |||||||
18–30 | 78 | 141,370 | 0.55 | 1.00 | - | 1.00 | - |
31–40 | 93 | 75,174 | 1.24 | 2.25 | (1.67, 3.04) *** | 1.89 | (1.40, 2.56) *** |
41–50 | 176 | 65,317 | 2.69 | 4.93 | (3.78, 6.44) *** | 3.17 | (2.39, 4.2) *** |
≥51 | 266 | 75,754 | 3.51 | 6.49 | (5.04, 8.36) *** | 2.49 | (1.83, 3.39) *** |
Comorbidities | |||||||
hypertension | |||||||
No | 416 | 298,632 | 1.39 | 1.00 | - | 1.00 | - |
Yes | 197 | 58,983 | 3.34 | 2.43 | (2.05, 2.88) *** | 0.78 | (0.60, 1.00) * |
diabetes mellitus | |||||||
No | 501 | 331,883 | 1.51 | 1.00 | - | 1.00 | - |
Yes | 112 | 25,732 | 4.35 | 2.92 | (2.38, 3.59) *** | 1.21 | (0.96, 1.52) |
hyperlipidemia | |||||||
No | 375 | 298,695 | 1.26 | 1.00 | - | 1.00 | - |
Yes | 238 | 58,919 | 4.04 | 3.25 | (2.76, 3.82) *** | 1.63 | (1.34, 1.97) *** |
Stroke | |||||||
No | 581 | 344,885 | 1.68 | 1.00 | - | 1.00 | - |
Yes | 32 | 12,729 | 2.51 | 1.52 | (1.06, 2.17) * | 0.60 | (0.41, 0.86) ** |
CAD | |||||||
No | 602 | 353,790 | 1.7 | 1.00 | - | ||
Yes | 11 | 3825 | 2.88 | 1.70 | (0.94, 3.09) | ||
CKD | |||||||
No | 606 | 354,713 | 1.71 | 1.00 | - | ||
Yes | 7 | 2902 | 2.41 | 1.45 | (0.69, 3.05) | ||
COPD | |||||||
No | 509 | 325,821 | 1.56 | 1.00 | - | 1.00 | - |
Yes | 104 | 31,794 | 3.27 | 2.10 | (1.70, 2.59) *** | 1.03 | (0.82, 1.29) |
Alcohol-related illness | |||||||
No | 580 | 347,685 | 1.67 | 1.00 | - | 1.00 | - |
Yes | 33 | 9930 | 3.32 | 2.05 | (1.44, 2.91) *** | 1.43 | (1.01, 2.05) * |
HIV | |||||||
No | 613 | 357,109 | 1.72 | ||||
Yes | 0 | 506 | 0 | ||||
AID | |||||||
No | 590 | 352,918 | 1.67 | 1.00 | - | 1.00 | - |
Yes | 23 | 4696 | 4.9 | 2.95 | (1.94, 4.47) *** | 1.66 | (1.09, 2.53) * |
Spinal cord injury | |||||||
No | 613 | 357,445 | 1.71 | ||||
Yes | 0 | 170 | 0 | ||||
Pelvic fracture | |||||||
No | 613 | 357,599 | 1.71 | ||||
Yes | 0 | 16 | 0 | ||||
Burn of unspecified degree of genitalia | |||||||
No | 613 | 357,605 | 1.71 | ||||
Yes | 0 | 9 | 0 | ||||
Foreign body entering through orifice | |||||||
No | 523 | 321,822 | 1.63 | 1.00 | - | 1.00 | - |
Yes | 90 | 35,793 | 2.51 | 1.57 | (1.25, 1.96) *** | 1.20 | (0.96, 1.50) |
Injury to nerves and spinal cord | |||||||
No | 604 | 354,341 | 1.7 | 1.00 | - | ||
Yes | 9 | 3273 | 2.75 | 1.64 | (0.85, 3.17) | ||
Poisoning | |||||||
No | 610 | 354,612 | 1.72 | 1.00 | - | ||
Yes | 3 | 3003 | 1 | 0.58 | (0.19, 1.82) | ||
Medication | |||||||
a-blocker | |||||||
No | 316 | 307,984 | 1.03 | 1.00 | - | 1.00 | - |
Yes | 297 | 49,631 | 5.98 | 5.81 | (4.96, 6.81) *** | 4.07 | (3.33, 4.97) *** |
b-blocker | |||||||
No | 502 | 330,756 | 1.52 | 1.00 | - | 1.00 | - |
Yes | 111 | 26,859 | 4.13 | 2.70 | (2.19, 3.31) *** | 1.30 | (1.03, 1.64) * |
CCB | |||||||
No | 388 | 291,236 | 1.33 | 1.00 | - | 1.00 | - |
Yes | 225 | 66,378 | 3.39 | 2.53 | (2.15, 2.98) *** | 1.02 | (0.80, 1.30) |
diuretics | |||||||
No | 474 | 314,505 | 1.51 | 1.00 | - | 1.00 | - |
Yes | 139 | 43,110 | 3.22 | 2.12 | (1.76, 2.57) *** | 0.74 | (0.59, 0.93) * |
Treatment | |||||||
Radical cystectomy | |||||||
No | 613 | 357,555 | 1.71 | ||||
Yes | 0 | 60 | 0 | ||||
LAR + APR | |||||||
No | 610 | 357,350 | 1.71 | 1.00 | - | 1.00 | - |
Yes | 3 | 265 | 11.3 | 6.56 | (2.11, 20.41) ** | 2.70 | (0.86, 8.43) |
Variables | Non-HPV | HPV | p for Interaction | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
n | PY | IR | n | PY | IR | cHR | (95% CI) | aHR ꝉ | (95% CI) | ||
Age, year | 0.40 | ||||||||||
18–30 | 61 | 113,415 | 0.54 | 17 | 27,955 | 0.61 | 1.14 | (0.66, 1.94) | 1.14 | (0.67, 1.95) | |
31–40 | 67 | 60,335 | 1.11 | 26 | 14,839 | 1.75 | 1.61 | (1.03, 2.54) * | 1.65 | (1.05, 2.6) * | |
41–50 | 127 | 52,646 | 2.41 | 49 | 12,671 | 3.87 | 1.61 | (1.16, 2.24) ** | 1.63 | (1.17, 2.27) ** | |
≥51 | 177 | 59,740 | 2.96 | 89 | 16,013 | 5.56 | 1.87 | (1.45, 2.42) *** | 1.85 | (1.43, 2.39) *** | |
Comorbidities | |||||||||||
hypertension | 0.10 | ||||||||||
No | 303 | 239,303 | 1.27 | 113 | 59,329 | 1.9 | 1.51 | (1.22, 1.87) *** | 1.5 | (1.21, 1.87) *** | |
Yes | 129 | 46,833 | 2.75 | 68 | 12,150 | 5.6 | 2.05 | (1.53, 2.76) *** | 1.99 | (1.48, 2.68) *** | |
diabetes mellitus | 0.05 | ||||||||||
No | 364 | 266,014 | 1.37 | 137 | 65,869 | 2.08 | 1.52 | (1.25, 1.86) *** | 1.5 | (1.23, 1.82) *** | |
Yes | 68 | 20,122 | 3.38 | 44 | 5610 | 7.84 | 2.38 | (1.63, 3.49) *** | 2.39 | (1.63, 3.51) *** | |
hyperlipidemia | 0.89 | ||||||||||
No | 265 | 239,430 | 1.11 | 110 | 59,265 | 1.86 | 1.68 | (1.34, 2.1) *** | 1.69 | (1.36, 2.12) *** | |
Yes | 167 | 46,706 | 3.58 | 71 | 12,213 | 5.81 | 1.65 | (1.25, 2.18) *** | 1.58 | (1.19, 2.09) ** | |
Stroke | 0.001 | ||||||||||
No | 420 | 276,453 | 1.52 | 161 | 68,433 | 2.35 | 1.56 | (1.3, 1.87) *** | 1.53 | (1.28, 1.84) *** | |
Yes | 12 | 9684 | 1.24 | 20 | 3046 | 6.57 | 5.18 | (2.53, 10.6) *** | 4.82 | (2.34, 9.92) *** | |
CAD | 0.46 | ||||||||||
No | 424 | 283,349 | 1.5 | 178 | 70,441 | 2.53 | 1.7 | (1.42, 2.02) *** | 1.67 | (1.4, 1.99) *** | |
Yes | 8 | 2787 | 2.87 | 3 | 1037 | 2.89 | 1.07 | (0.28, 4.07) | 1.3 | (0.32, 5.23) | |
CKD | 0.27 | ||||||||||
No | 429 | 283,990 | 1.51 | 177 | 70,723 | 2.5 | 1.66 | (1.4, 1.98) *** | 1.63 | (1.36, 1.94) *** | |
Yes | 3 | 2147 | 1.4 | 4 | 755 | 5.3 | 3.64 | (0.81, 16.27) | 4.99 | (0.94, 26.6) | |
COPD | 0.03 | ||||||||||
No | 370 | 261,178 | 1.42 | 139 | 64,642 | 2.15 | 1.52 | (1.25, 1.85) *** | 1.5 | (1.23, 1.82) *** | |
Yes | 62 | 24,958 | 2.48 | 42 | 6836 | 6.14 | 2.56 | (1.73, 3.81) *** | 2.51 | (1.69, 3.74) *** | |
Alcohol-related illness | 0.17 | ||||||||||
No | 413 | 278,340 | 1.48 | 167 | 69,345 | 2.41 | 1.63 | (1.36, 1.95) *** | 1.6 | (1.34, 1.92) *** | |
Yes | 19 | 7796 | 2.44 | 14 | 2134 | 6.56 | 2.68 | (1.34, 5.34) ** | 2.52 | (1.25, 5.07) ** | |
HIV | 1.00 | ||||||||||
No | 432 | 285,790 | 1.51 | 181 | 71,319 | 2.54 | 1.69 | (1.42, 2.01) *** | 1.64 | (1.38, 1.96) *** | |
Yes | 0 | 347 | 0 | 0 | 159 | 0 | |||||
AID | 0.17 | ||||||||||
No | 420 | 282,571 | 1.49 | 170 | 70,347 | 2.42 | 1.63 | (1.37, 1.95) *** | 1.62 | (1.35, 1.93) *** | |
Yes | 12 | 3566 | 3.37 | 11 | 1131 | 9.73 | 2.85 | (1.26, 6.46) * | 2.44 | (1.07, 5.6) * | |
Medication | |||||||||||
a-blocker | 0.47 | ||||||||||
No | 228 | 246,731 | 0.92 | 88 | 61,253 | 1.44 | 1.56 | (1.22, 1.99) *** | 1.55 | (1.21, 1.98) *** | |
Yes | 204 | 39,405 | 5.18 | 93 | 10,226 | 9.09 | 1.76 | (1.37, 2.25) *** | 1.75 | (1.37, 2.24) *** | |
b-blocker | 0.82 | ||||||||||
No | 355 | 264,742 | 1.34 | 147 | 66,014 | 2.23 | 1.66 | (1.37, 2.02) *** | 1.63 | (1.35, 1.98) *** | |
Yes | 77 | 21,394 | 3.6 | 34 | 5464 | 6.22 | 1.75 | (1.16, 2.62) ** | 1.7 | (1.13, 2.56) * | |
CCB | 0.07 | ||||||||||
No | 283 | 232,996 | 1.21 | 105 | 58,240 | 1.8 | 1.49 | (1.19, 1.86) *** | 1.45 | (1.16, 1.82) ** | |
Yes | 149 | 53,140 | 2.8 | 76 | 13,238 | 5.74 | 2.06 | (1.56, 2.72) *** | 2.02 | (1.53, 2.67) *** | |
Diuretics | 0.25 | ||||||||||
No | 340 | 251,848 | 1.35 | 134 | 62,657 | 2.14 | 1.58 | (1.3, 1.93) *** | 1.54 | (1.26, 1.88) *** | |
Yes | 92 | 34,289 | 2.68 | 47 | 8821 | 5.33 | 2.06 | (1.45, 2.93) *** | 2.07 | (1.45, 2.96) *** |
Non-HPV | HPV | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Follow-Up, Year | n | PY | IR | N | PY | IR | cHR | (95% CI) | aHR ꝉ | (95% CI) |
<1 | 58 | 52,691 | 0.11 | 40 | 13,210 | 0.30 | 1.67 | (1.41, 1.99) *** | 1.64 | (1.38, 1.95) *** |
1–5 | 238 | 262,705 | 0.09 | 86 | 65,757 | 0.13 | 1.51 | (1.24, 1.83) *** | 1.48 | (1.22, 1.80) *** |
>5 | 136 | 212,530 | 0.06 | 55 | 53,049 | 0.10 | 1.67 | (1.22, 2.29) ** | 1.7 | (1.24, 2.34) *** |
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Juang, S.-E.; Ma, K.S.-K.; Kao, P.-E.; Wei, J.C.-C.; Yip, H.-T.; Chou, M.-C.; Hung, Y.-M.; Chin, N.-C. Human Papillomavirus Infection and the Risk of Erectile Dysfunction: A Nationwide Population-Based Matched Cohort Study. J. Pers. Med. 2022, 12, 699. https://doi.org/10.3390/jpm12050699
Juang S-E, Ma KS-K, Kao P-E, Wei JC-C, Yip H-T, Chou M-C, Hung Y-M, Chin N-C. Human Papillomavirus Infection and the Risk of Erectile Dysfunction: A Nationwide Population-Based Matched Cohort Study. Journal of Personalized Medicine. 2022; 12(5):699. https://doi.org/10.3390/jpm12050699
Chicago/Turabian StyleJuang, Sin-Ei, Kevin Sheng-Kai Ma, Pei-En Kao, James Cheng-Chung Wei, Hei-Tung Yip, Mei-Chia Chou, Yao-Min Hung, and Ning-Chien Chin. 2022. "Human Papillomavirus Infection and the Risk of Erectile Dysfunction: A Nationwide Population-Based Matched Cohort Study" Journal of Personalized Medicine 12, no. 5: 699. https://doi.org/10.3390/jpm12050699