International Journal of Impotence Research (2002) 14, Suppl 2, S10–S18 ß 2002 Nature Publishing Group All rights reserved 0955-9930/02 $25.00 www.nature.com/ijir ]>DOI: 0955-9930 Nature Publishing Group Prevalence of erectile dysfunction in Colombia, Ecuador, and Venezuela: a population-based study (DENSA) LE Morillo1*, J Dı´az1, E Estevez2, A Costa3,HMe´ndez4,HDa´vila5, N Medero5, N Rodriguez1, M Chaves6, R Vinueza6, JA Ortiz6 and DB Glasser7 for the DENSA Study Group 1Faculty of Medicine Pontificia Universidad Javeriana, Santafe´ de Bogota´ DC, Colombia; 2Universidad Central del Ecuador, Quito, Ecuador; 3Sociedad Ecuatoriana de Urologı´a, Quito, Ecuador; 4Fundacredesa, Caracas, Venezuela; 5Sociedad Venezolana de Urologı´a, Caracas, Venezuela; 6Pfizer Inc, CELA Region, Bogota´, Colombia; and 7Pfizer Inc, New York, NY, USA The purpose of this study was to estimate the prevalence of erectile dysfunction (ED) in Colombia, Ecuador, and Venezuela. A 49-item questionnaire was completed by 1946 men aged 40 years and older. The age-adjusted combined prevalence of minimal, moderate, and complete ED for all three countries was 53.4%, with 19.8% of all men reporting moderate to complete ED. Age was the variable most strongly linked to ED; the prevalence of complete ED increased markedly in men older than 79 y of age (31.9%) and 70 – 79 y (17.2%) compared with men aged 40 – 49 y (<3%). Several medical conditions, such as hypertension, benign prostatic hyperplasia, and diabetes, and the use of medications to treat these conditions were correlated with the prevalence of ED. This study corroborates earlier studies demonstrating that ED is very common, increases dramatically with age, and has multiple correlates, including some that are also risk factors for cardiovascular disease. International Journal of Impotence Research (2002) 14, Suppl 2, S10–S18. doi:10.1038=sj.ijir.3900893 Keywords: erectile dysfunction; Latin America; prevalence; risk factors Introduction conditions (hypertension, diabetes, heart disease, benign prostatic hyperplasia [BPH], prostate cancer, renal failure, depression), medical treat- Significant advances in the understanding of male ments,6,14,17 – 24 and lifestyle factors (smoking, sexual dysfunction over the past two decades have alcohol consumption, body size, and physical shown that erectile dysfunction (ED), the persistent exercise)25 – 29 have been correlated with ED. = inability to achieve and or maintain an erection The overall prevalence of ED has been esti- 1 sufficient for sexual activity, is highly prevalent mated to be 52% in the USA,6 50% in Japan (men 2 worldwide. Several epidemiological studies have aged 70 – 79 y),30 42% in France,31 22% in the UK,32 3–8 9–13 been conducted in the USA and elsewhere, and 19% in Germany11 and Spain.12 The present but most of these studies were limited to restricted study was undertaken to determine the prevalence geographic regions or were not population-based. of ED and associated socioeconomic and health- Because ED is not a life-threatening condition and related factors among men aged 40 y and older who because men often do not seek treatment, less is live in three South American countries. known about the prevalence of ED and associated socioeconomic and health-related correlates in various geographic, socioeconomic, ethnic, racial, and cultural groups.1 Methods A number of sociodemographic factors (age, education, income, marital status),3 – 5,14 – 16 medical Sampling *Correspondence: LE Morillo MSc, MD, Hospital San Igancio, Men aged 40 y and older were randomly selected in c=o Unidad de Epidemiologic Clinica, Carrera 7 No. 40 – 62, a multi-stage sampling procedure from the most Segundo piso, Bogota, Colombia densely populated cities of Colombia and Ecuador. Prevalence rate of ED in northern South America LE Morillo et al S11 These cities were selected based on local census Cities in Venezuela are divided into munici- data and included Bogota´, Medellı´n, Cali, and palities (municipios). The number of blocks (man- Barranquilla in Colombia and Quito and Guayaquil zanas) surveyed within each municipality was in Ecuador. In Venezuela, lack of sufficient census proportional to the size of its population, with a data to be used as a sampling frame for random minimum requirement of 150 households per block. selection forced the use of a convenience sample in Although blocks were selected by convenience multiple cities. The cities selected in Venezuela mainly due to safety issues, efforts were made to were Caracas, Valencia, Maracaibo, and Barquisi- select blocks distributed widely throughout the city. meto. The population of the cities selected in In any selected block, a simple random selection of Colombia, Ecuador, and Venezuela represented households was done. If the number of interviewed 31%, 28%, and 30% of the total population of each men fell short of the required number, additional country, respectively. Using an assumed ED pre- households were selected within the same block. valence of 52%, the total sample size necessary to estimate prevalence within Æ 4% (P ¼ 0.05) was estimated to be 600 for each country. The primary sampling unit in Colombia consisted Interview protocol of a grouping of households known as an urban sector (barrio). Urban sectors are well-defined areas with physical boundaries such as streets, avenues, or Either male general practitioners or nursing= parks and are homogeneous with regard to socio- psychology students from the respective cities served economic status. Using a simple random procedure, as interviewers and received training to ensure their four urban sectors were selected based on 1991 familiarity with the purpose of the study, the content census data from the Departamento Administrativo of the questionnaire, and proper interviewing tech- Nacional de Estadistica (National Statistics Depart- niques. Interviews were performed approximately ment). Urban sectors are divided into sections one week following public announcements in the (secciones) and further into blocks (manzanas). local media raising awareness about male sexual Based on detailed cartographic information on urban health and promoting the importance of this survey. sectors selected in the first stage, a simple random Men aged 40 y and older contacted in the selected selection of sections and blocks was done. The areas were invited to participate and received a brief number of households necessary to meet the require- explanation of the purpose of the survey. Participa- ments for sample size was estimated based on tion was voluntary, and interviews could be termi- additional census information (eg, number of house- nated at any time. All interviews were conducted holds within each selected block, number of resi- face-to-face and averaged approximately 20 min. dents per household). All households within Internal review boards or ethics committees in each selected blocks were surveyed and contacted by field surveyed country approved the interview protocol. teams. If the number of interviewed men fell short of the required number, additional households were selected within the same section of the urban sector. A similar procedure was used in Ecuador. In the The questionnaire first stage, health areas were selected using a simple random selection process. Each health area is subdivided into homogeneous sectors (sectores) that The same 49-item questionnaire was used in each are roughly equivalent to the urban sector (barrio) in country, covering demographics, socioeconomic Colombia. Health areas are geopolitical divisions status, health status, perceptions of sexual perfor- based on socioeconomic factors and availability of mance, and satisfaction with sex life. health resources to the population and thus con- Questions adapted from the Pfizer Cross-National stitute a heterogeneous cluster. Sectors are nearly Study of the Prevalence and Correlates of ED2 and homogeneous with respect to socioeconomic status the abridged 5-item version of the International and are subdivided into blocks and further into Index of Erectile Function33 that addresses issues of households. A random sample selection was made sexual activity and satisfaction were translated into based on cartographic information available from a culturally and linguistically validated Spanish the Instituto Nacional de Estadisticas y Censos version. ED was classified by a single question. Men (National Institute of Statistics and Census). The rated their ability to achieve and maintain an information on health sectors is frequently updated erection sufficient for sexual intercourse according and is considered to be a more reliable source for to the following categories: always, most of the time, determining a representative sample. As described rarely, never able. This enabled categorization of ED for Colombia, additional blocks were selected into four degrees of severity: none; minimal; beforehand and used if the original selection was moderate; and complete. insufficient to complete the pre-established number The Graffar-Me´ndez-Castellano24 method was of interviews. used to assess socioeconomic status. It consisted of International Journal of Impotence Research Prevalence rate of ED in northern South America LE Morillo et al S12 four questions identifying type of employment, ical conditions, and type of medications used to education, income, and living conditions. treat these conditions. Medical correlates were defined as medical Chi-square (Pearson) tests of the above variables conditions having been diagnosed by a