Recent findings from the Boston Area Community Health (BACH) Survey have pro-vided further evidence of the association of ED with prevalent comorbid conditions and modifiable risk factors in a large population-based epidemiologic study, as well as new insights on the role of socioeconomic status (SES) and race/ethnic disparities in ED, as well as the complex interaction between ED, chronic illnesses, and prescription medication use.

BACH is a community-based epidemiologic study of a broad range of urologic symptoms in a random sample of over 5,500 adults, including 2,301 men age 30–79 years. The BACH study used a multistage-stratified design to recruit approximately equal numbers by age decade, gender, and race/ethnicity, resulting in a population representative, diverse sample. Multidisciplinary data collected through an extensive in home interview include a wide range of covariates, including anthropometric and blood pressure measurements, venous blood sample collection, self-reported medical history, sociodemographic characteristics, and lifestyle and psychosocial factors as well as administration of an extensive sexual questionnaire, including the International Index of Erectile Function with viagra online Australia (IIEF-5). Medication use was collected using a combination of drug inventory and self-report with a prompt by indication.

Consistent with findings from previous studies, results of the BACH study show a strong association between ED and major chronic illnesses, such as heart disease, diabetes, and depression with an approximately twofold increase in risk of ED. A comparable association between hypertension and ED disappeared only after adjusting for heart disease and diabetes. While the association between overall obesity, assessed by BMI and ED was weak, a much stronger association was observed when considering abdominal obesity measured by waist-to-hip ratio. Similar to the association of ED and hypertension, the effect of abdominal obesity was nonsignificant only after controlling diabetes and heart disease. Overall, these results were consistent across race/ethnic groups, with only minor observed differences between groups.

Results from the BACH study also contribute to the growing body of evidence showing an association between ED and LUTS. We further investigated the contribution of urinary incontinence and prostatitis which are common voiding symptoms not included in the AUA symptom index. The observed association in BACH between ED and LUTS, both conditions with increasing prevalence in aging men, is consistent with findings from previous studies, BACH data shows that this association is primarily due to nocturia, and symptoms of urinary incontinence and prostatitis, with results again consistent across race/ethnic groups. Similar results were recently observed when investigating the association between urinary symptoms and low sexual desire.

In addition to the role of comorbid medical conditions, BACH findings also provide support for the contribution of potentially modifiable behavioral risk factors, such as physical activity, smoking, and alcohol consumption in their effects on ED. Results show a weak association between alcohol consumption and ED, in particular, with no evidence for a linear trend, as moderate alcohol consumption was associated with a slight decreased in risk while increased amounts were associated with very slightly higher risk of ED. On the other hand, a clear trend in decreased risk of ED was observed with increased physical activity. BACH data also provide further evidence of the increased risk of ED associated with smoking with a strong dose-response pattern in between duration and intensity of smoking and increased risk of ED with a significant increase in ED risk with exposure to 20 pack-years or more. BACH data also permits the assessment of the impact of exposure to second hand smoke (pas-sive smoking) and shows a moderate, statistically nonsignificant, increase in the risk of ED comparable to the effect observed for 10–19 years of smoking. These results highlight the importance and opportunity for the intervention on modifiable behavioral factors, such as smoking cessation and increased physical activity in prevention or improvement in erectile function as well as the possibility of adverse effects of long-term chronic exposure to passive smoking.