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Race and Ethnicity Have a Significant Effect on the Disclosure of Erectile Function: An Analysis of NHANES Response Patterns

      Abstract

      OBJECTIVES

      To determine if race/ethnicity impacts disclosure of erectile function.

      METHODS

      Data on age, education, erectile function, and past medical history were obtained from the National Health and Nutrition Examination Survey. Response rates to a single survey question regarding erectile function were calculated and compared between race/ethnicity groups. Two subgroups were created by excluding non-responders to questions about hypertension and prostate disease to control for overall non-responsiveness and urologic health literacy.

      RESULTS

      Our final cohort consisted of 4,694 men. Overall, 3,898 (83.0%) responded to the erectile function survey question. Race/ethnicity was a significant factor in overall response rates to the Erectile function question: 85.2% in non-hispanic white, 82.3% in non-hispanic black, 81.2% in hispanic, and 64.8% in other subjects (P<.001). Race/ethnicity remained significantly associated with responses rates among both subgroups. Multivariate logistic regression using the prostate disease subgroup showed that non-hispanic black (AOR = 2.02, 95% CI 1.01-4.03, P = .047) and hispanic (AOR = 2.18, 95% CI 1.19-4.00, P = .012) participants were significantly more likely to not disclose their erectile function compared to non-hispanic white participants after controlling for age and education.

      CONCLUSION

      Non-hispanic black and hispanic men were significantly less likely to disclose their erectile function than non-hispanic white men in an anonymous, nationally representative survey. A better understanding of how cultural differences affect reporting of erectile function is important in improving patient care and accurately studying outcomes of urological procedures.
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      References

        • Burnett AL
        • Nehra A
        • Breau RH
        • et al.
        Erectile dysfunction: AUA guideline.
        J Urol. 2018; 200: 633-641
        • Hatzimouratidis K
        • Amar E
        • Eardley I
        • et al.
        Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation.
        Eur Urol. 2010; 57: 804-814
        • Nehra A
        • Kulaksizoglu H.
        Global perspectives and controversies in the epidemiology of male erectile dysfunction.
        Curr Opin Urol. 2002; 12: 493-496
        • Klein JB
        • Nguyen CT
        • Saffore L
        • Modlin 3rd, C
        • Modlin Jr., CS
        Racial disparities in urologic health care.
        J Natl Med Assoc. 2010; 102: 108-117
        • Bailey ZD
        • Krieger N
        • Agénor M
        • Graves J
        • Linos N
        • Bassett MT.
        Structural racism and health inequities in the USA: evidence and interventions.
        Lancet. 2017; 389: 1453-1463
      1. Statistics NCfH. NHANES Survey Methods and Analytic Guidelines. Available from: https://wwwn.cdc.gov/nchs/nhanes/analyticguidelines.aspx. Access January 10, 2021

        • Flanagin A
        • Frey T
        • Christiansen SL
        • Bauchner H.
        The reporting of race and ethnicity in medical and science journals: comments invited.
        JAMA. 2021; 325: 1049-1052
        • Iverson C CS
        • Flanagin A
        • et al.
        Recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals.
        International Committee of Medical Journal Editors. 2021; (December 8)
        • Araujo AB
        • Travison TG
        • Ganz P
        • et al.
        Erectile dysfunction and mortality.
        J Sex Med. 2009; 6: 2445-2454
        • Feldman HA
        • Goldstein I
        • Hatzichristou DG
        • Krane RJ
        • McKinlay JB.
        Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.
        J Urol. 1994; 151: 54-61
        • Selvin E
        • Burnett AL
        • Platz EA.
        Prevalence and risk factors for erectile dysfunction in the US.
        Am J Med. 2007; 120: 151-157
        • Saigal CS
        • Wessells H
        • Pace J
        • Schonlau M
        • Wilt TJ.
        Predictors and prevalence of erectile dysfunction in a racially diverse population.
        Arch Intern Med. 2006; 166: 207-212
        • Kupelian V
        • Link CL
        • Rosen RC
        • McKinlay JB.
        Socioeconomic status, not race/ethnicity, contributes to variation in the prevalence of erectile dysfunction: results from the Boston Area Community Health (BACH) Survey.
        J Sex Med. 2008; 5: 1325-1333
        • Rezaee ME
        • Ward CE
        • Gross MS.
        Differences in healthcare expenditures, visits, and prescriptions by race for common benign urologic conditions.
        Urology. 2022; 162: 70-76https://doi.org/10.1016/j.urology.2021.06.026
        • Jackson R
        • Chambless LE
        • Yang K
        • et al.
        Differences between respondents and nonrespondents in a multicenter community-based study vary by gender and ethnicity.
        J Clin Epidemiol. 1996; 49: 1441-1446
        • Peltz-Rauchman CD
        • Divine G
        • McLaren D
        • et al.
        Response to survey directed to patient portal members differs by age, race, and healthcare utilization.
        JAMIA Open. 2019; 2: 429-433
        • Tolonen H
        • Dobson A
        • Kulathinal S
        • Project WM.
        Effect on trend estimates of the difference between survey respondents and non-respondents: results from 27 populations in the WHO MONICA Project.
        Eur J Epidemiol. 2005; 20: 887-898
        • Lahaut VM
        • Jansen HA
        • van de Mheen D
        • Garretsen HF
        • Verdurmen JE
        • Van Dijk A.
        Estimating non-response bias in a survey on alcohol consumption: comparison of response waves.
        Alcohol Alcoholism. 2003; 38: 128-134
        • Tourangeau R
        • Yan T.
        Sensitive questions in surveys.
        Psychological Bulletin. 2007; 133: 859
        • Abreu JM
        • Goodyear RK
        • Campos A
        • Newcomb MD.
        Ethnic belonging and traditional masculinity ideology among African Americans, European Americans, and Latinos.
        Psychol Men Masculinity. 2000; 1: 75
        • Person ES.
        Sexuality as the mainstay of identity: psychoanalytic perspectives.
        Signs: J Women Culture Soc. 1980; 5: 605-630
        • Fugitt JL
        • Ham LS
        • Bridges AJ.
        Undifferentiated gender role orientation, drinking motives, and increased alcohol use in men and women.
        Substance Use Misuse. 2017; 52: 760-772
        • Komlenac N
        • Siller H
        • Bliem HR
        • Hochleitner M.
        Associations between gender role conflict, sexual dysfunctions, and male patients’ wish for physician–patient conversations about sexual health.
        Psychol Men Masculinities. 2019; 20: 337
        • Bazargan M
        • Cobb S
        • Assari S
        Discrimination and medical mistrust in a racially and ethnically diverse sample of California adults.
        Annal Family Med. 2021; 19: 4-15
        • Ficarra V
        • Novara G
        • Ahlering TE
        • et al.
        Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy.
        Eur Urol. 2012; 62: 418-430
        • Xiong X
        • Qiu S
        • Yi X
        • et al.
        Effect of neurovascular bundle sparing radical cystectomy on post-operative continence and sexual function: a systematic review and meta-analysis.
        Andrology. 2021; 9: 221-232
        • Gaither TW
        • Awad MA
        • Osterberg EC
        • et al.
        The natural history of erectile dysfunction after prostatic radiotherapy: a systematic review and meta-analysis.
        J Sex Med. 2017; 14: 1071-1078
        • Gonzalez G
        • Dallas K
        • Arora A
        • Kobashi KC
        • Anger JT.
        Underrepresentation of racial and ethnic diversity in research informing the American urological association/society of urodynamics, female pelvic medicine & urogenital reconstruction stress urinary incontinence guideline.
        Urology. 2022; 163: 16-21https://doi.org/10.1016/j.urology.2021.08.038
        • Brown O
        • Siddique M
        • Mou T
        • Boniface ER
        • Volpe KA
        • Cichowski S.
        Disparity of racial/ethnic representation in publications contributing to overactive bladder diagnosis and treatment guidelines.
        Female Pelvic Med Reconstr Surg. 2021; 27: 541-546
        • Larrison CR
        • Schoppelrey SL
        • Hack-Ritzo S
        • Korr WS.
        Clinician factors related to outcome differences between black and white patients at CMHCs.
        Psychiatr Serv. 2011; 62: 525-531