Association between social determinants of health and erectile dysfunction: insights from a nationally representative US sample.

Background: Beyond traditional risk factors, public health has increasingly focused on the impact of social determinants of health (SDoHs) on disease risk. However, no studies have systematically evaluated the effects of both individual and cumulative SDoHs on the risk of erectile dysfunction (ED), representing a critical gap that our study aims to address. Methods: Data were collected from a representative sample of adult men participating in the U.S. National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004. Self-reported SDoHs were categorized based on Healthy People 2030 criteria, with a cumulative score of favorable SDoHs created for analysis. ED was assessed using a validated single-item measure. Multivariable regression models were used to examine the effects of individual and cumulative SDoHs on ED risk. Subgroup and sensitivity analyses were conducted to enhance the robustness of the results. Results: A total of 3,489 eligible participants were included, with 1,001 diagnosed with ED. Unfavorable SDoHs showed significant associations with increased ED risk: being unemployed [odds ratio (OR): 1.97, 95% confidence interval (CI): 1.40, 2.77], family income-to-poverty ratio <300% (OR: 1.65, 95% CI: 1.32, 2.06, P<0.001), marginal-to-very-low food security (OR: 1.50, 95% CI: 1.02, 2.20, P=0.04), high school education or lower (OR: 1.41, 95% CI: 1.09, 1.81, P=0.01), and non-homeownership (OR: 1.23, 95% CI: 1.01, 1.53, P=0.04). A strong inverse relationship was observed between the cumulative count of favorable SDoHs and ED risk (OR: 0.83, 95% CI: 0.75, 0.93, P=0.002). When treated as categorical variables, lower-middle [3-4] and low levels [0-2] of SDoHs were associated with higher ED risk (ORs: 1.76 and 2.62, P<0.05). Additionally, sensitivity analysis showed that the low-level group (0-2 SDoHs) had a significantly higher risk of severe ED compared to the high-level group (OR =3.78, 95% CI: 1.26, 11.34, P=0.02). Conclusions: The findings suggest that unfavorable SDoHs, particularly when accumulated, are associated with increased risk of ED among U.S. men. Addressing unfavorable SDoHs should be a public health priority, not only to improve male sexual health, but also to promote health equity and overall population well-being. Large-scale population cohort studies are underway to provide higher-level evidence supporting our conclusions.