Associations between organic erectile dysfunction and the risk of herpes zoster and postherpetic neuralgia in men

Figures & data

Figure 1. Flow chart of the patients’ selection.

Table 1. Baseline characteristics for organic erectile dysfunction cohort and control cohort.

Variables	Organic erectile dysfunction				SMD
	No (N = 20808)		Yes (N = 20808)
	n	%	n	%
Age, years
20–39	3648	17.53	3660	17.59	0.002
40–59	10134	48.70	10342	49.70	0.020
≥60	7026	33.77	6806	32.71	0.022
Mean ± SD^a	53.42	±14.17	52.96	±13.55	0.033
Comorbidities
Diabetes Mellitus	4856	23.34	4851	23.31	0.001
Chronic kidney disease	557	2.68	589	2.83	0.009
Coronary artery disease	4277	20.55	4304	20.68	0.003
Cancer	626	3.01	706	3.39	0.022
Depression	1804	8.67	1956	9.40	0.025
Medication
Metformin	3269	15.71	3257	15.65	0.002
B-blockers	5138	24.69	5127	24.64	0.001
SSRIs	1160	5.57	1205	5.79	0.009
Mean follow-up time ± SD^a, years
Herpes zoster	8.49	±5.18	8.63	±5.17	0.027
Postherpetic neuralgia	8.70	±5.21	9.14	±5.21	0.085

^a t-test; Chi-square test; SD: standard deviation.

Figure 2. (a) Illustrates the cumulative incidence of herpes zoster among patients diagnosed with organic erectile dysfunction compared to those without the condition, where the X-axis denotes time elapsed since initial diagnosis in years, and the Y-axis represents the probability of developing herpes zoster over time. Conversely, (b) presents a similar comparative analysis for the cumulative incidence of postherpetic neuralgia, offering insights into the progression of this complication following herpes zoster.

Table 2a. Incidences and hazard ratios of herpes zoster for individuals with and without organic erectile dysfunction by age, comorbidities and medication.

Variables	Herpes zoster			cHR	(95% CI)	p-value	aHR	(95% CI)	p-value
	n	PY	IR
Organic erectile dysfunction
No	1133	176689.01	6.41	1.00	(reference)	–	1.00	(reference)	–
Yes	2020	179624.07	11.25	1.75	(1.63, 1.88)***	<0.001	1.74	(1.62, 1.88)***	<0.001
Age, years
20–39	270	64356.34	4.20	1.00	(reference)	–	1.00	(reference)	–
40–59	1469	178760.45	8.22	1.97	(1.73, 2.24)***	<0.001	1.88	(1.65, 2.14)***	<0.001
≥60	1414	113196.29	12.49	3.02	(2.65, 3.44)***	<0.001	2.75	(2.4, 3.14)***	<0.001
Comorbidities
Diabetes Mellitus
No	2404	283071.59	8.49	1.00	(reference)	–	1.00	(reference)	–
Yes	749	73241.49	10.23	1.25	(1.15, 1.36)***	<0.001	1.04	(0.93, 1.17)	0.466
Chronic kidney disease
No	3072	349252.77	8.80	1.00	(reference)	–	1.00	(reference)	–
Yes	81	7060.32	11.47	1.37	(1.10, 1.71)**	0.005	1.09	(0.87, 1.36)	0.454
Coronary artery disease
No	2355	291026.68	8.09	1.00	(reference)	–	1.00	(reference)	–
Yes	798	65286.41	12.22	1.57	(1.45, 1.70)***	<0.001	1.21	(1.10, 1.32)***	<0.001
Cancer
No	3060	347829.23	8.80	1.00	(reference)	–	1.00	(reference)	–
Yes	93	8483.86	10.96	1.30	(1.06, 1.60)*	0.013	1.03	(0.84, 1.27)	0.793
Depression
No	2915	329195.03	8.85	1.00	(reference)	–	1.00	(reference)	–
Yes	238	27118.06	8.78	1.03	(0.91, 1.18)	0.625	0.93	(0.8, 1.08)	0.361
Medication
Metformin
No	2688	309720.64	8.68	1.00	(reference)	–	1.00	(reference)	–
Yes	465	46592.45	9.98	1.20	(1.09, 1.33)***	<0.001	0.99	(0.86, 1.14)	0.891
B-blockers
No	2365	282319.34	8.38	1.00	(reference)	–	1.00	(reference)	–
Yes	788	73993.75	10.65	1.34	(1.24, 1.45)***	<0.001	1.19	(1.09, 1.29)***	<0.001
SSRIs
No	3033	341484.25	8.88	1.00	(reference)	–	1.00	(reference)	–
Yes	120	14828.84	8.09	0.98	(0.81, 1.17)	0.804	0.95	(0.78, 1.17)	0.658

PY: person-year; IR: incidence rate, per 1000 person-years; cHR: crude hazard ratio; aHR: adjusted hazard ratio, adjusted for age, comorbidities and medication; CI: confidence interval; *p < 0.05, **p < 0.01, ***p < 0.001.

Table 2b. Incidences and hazard ratios of postherpetic neuralgia for individuals with and without organic erectile dysfunction by age, comorbidities and medication.

Variables	Postherpetic neuralgia			cHR	(95% CI)	p-value	aHR	(95% CI)	p-value
	n	PY	IR
Organic erectile dysfunction
No	144	180983.63	0.80	1.00	(reference)	–	1.00	(reference)	–
Yes	248	190195.09	1.30	1.61	(1.31, 1.97)***	<0.001	1.56	(1.27, 1.92)***	<0.001
Age, years
20–39	23	65596.01	0.35	1.00	(reference)	–	1.00	(reference)	–
40–59	159	185775.82	0.86	2.45	(1.58, 3.79)***	<0.001	2.20	(1.41, 3.41)***	<0.001
≥60	210	119806.89	1.75	5.12	(3.33, 7.87)***	<0.001	4.31	(2.77, 6.7)***	<0.001
Comorbidities
Diabetes Mellitus
No	281	294653.89	0.95	1.00	(reference)	–	1.00	(reference)	–
Yes	111	76524.84	1.45	1.7	(1.36, 2.12)***	<0.001	1.24	(0.91, 1.7)	0.168
Chronic kidney disease
No	381	363838.90	1.05	1.00	(reference)	–	1.00	(reference)	–
Yes	11	7339.82	1.50	1.68	(0.92, 3.06)	0.091	1.15	(0.63, 2.1)	0.654
Coronary artery disease
No	285	302350.87	0.94	1.00	(reference)	–	1.00	(reference)	–
Yes	107	68827.85	1.55	1.85	(1.48, 2.31)***	<0.001	1.13	(0.89, 1.45)	0.320
Cancer
No	380	362296.51	1.05	1.00	(reference)	–	1.00	(reference)	–
Yes	12	8882.21	1.35	1.46	(0.82, 2.59)	0.20	1.05	(0.59, 1.87)	0.875
Depression
No	353	343090.19	1.03	1.00	(reference)	–	1.00	(reference)	–
Yes	39	28088.54	1.39	1.55	(1.11, 2.16)**	0.01	1.22	(0.83, 1.79)	0.323
Medication
Metformin
No	322	322532.45	1.00	1.00	(reference)	–	1.00	(reference)	–
Yes	70	48646.27	1.44	1.66	(1.28, 2.15)***	<0.001	1.15	(0.80, 1.64)	0.461
B-blockers
No	278	294079.63	0.95	1.00	(reference)	–	1.00	(reference)	–
Yes	114	77099.10	1.48	1.85	(1.48, 2.3)***	<0.001	1.52	(1.20, 1.93)***	<0.001
SSRIs
No	373	355870.02	1.05	1.00	(reference)	–	1.00	(reference)	–
Yes	19	15308.70	1.24	1.49	(0.94, 2.37)	0.091	1.15	(0.68, 1.96)	0.600

PY: person-year; IR: incidence rate, per 1000 person-years; cHR: crude hazard ratio; aHR: adjusted hazard ratio, adjusted for age, comorbidities and medication; CI: confidence interval; *p < 0.05, **p < 0.01, ***p < 0.001.

Table 3a. Cox proportional hazards regression analysis for the risk of herpes zoster.

Variables	Organic erectile dysfunction						cHR	(95% CI)	p-value	aHR	(95% CI)	p-value
	No			Yes
	n	PY	IR	n	PY	IR
Age, year
20–39	112	32168.41	3.48	158	32187.94	4.91	1.41	(1.11, 1.80)**	0.005	1.41	(1.11, 1.80)**	0.005
40–59	548	88480.26	6.19	921	90280.19	10.20	1.65	(1.48, 1.83)***	<0.001	1.65	(1.48, 1.83)***	<0.001
≥60	473	56040.35	8.44	941	57155.94	16.46	1.94	(1.74, 2.17)***	<0.001	1.93	(1.73, 2.16)***	<0.001
Comorbidities
No	634	109476.24	5.79	1070	109060.28	9.81	1.69	(1.53, 1.87)***	<0.001	1.69	(1.53, 1.87)***	<0.001
Yes	499	67212.77	7.42	950	70563.79	13.46	1.81	(1.62, 2.01)***	<0.001	1.81	(1.62, 2.01)***	<0.001
Diabetes Mellitus
No	887	140923.81	6.29	1517	142147.78	10.67	1.69	(1.56, 1.84)***	<0.001	1.69	(1.55, 1.83)***	<0.001
Yes	246	35765.20	6.88	503	37476.29	13.42	1.94	(1.67, 2.26)***	<0.001	1.93	(1.66, 2.25)***	<0.001
Chronic kidney disease
No	1105	173575.10	6.37	1967	175677.66	11.20	1.76	(1.63, 1.89)***	<0.001	1.75	(1.63, 1.89)***	<0.001
Yes	28	3113.91	8.99	53	3946.41	13.43	1.49	(0.94, 2.36)	0.087	1.52	(0.96, 2.41)	0.077
Coronary artery disease
No	853	144891.49	5.89	1502	146135.19	10.28	1.74	(1.60, 1.90)***	<0.001	1.74	(1.60, 1.89)***	<0.001
Yes	280	31797.53	8.81	518	33488.88	15.47	1.75	(1.51, 2.02)***	<0.001	1.95	(1.53, 2.05)***	<0.001
Cancer
No	1107	173013.14	6.40	1953	174816.09	11.17	1.74	(1.62, 1.88)***	<0.001	1.70	(1.62, 1.87)***	<0.001
Yes	26	3675.88	7.07	67	4807.98	13.94	1.92	(1.22, 3.03)**	0.005	1.95	(1.23, 3.07)**	0.004
Depression
No	1072	164063.47	6.53	1843	165131.56	11.16	1.71	(1.58, 1.84)***	<0.001	1.70	(1.58, 1.84)***	<0.001
Yes	61	12625.54	4.83	177	14492.51	12.21	2.51	(1.88, 3.36)***	<0.001	2.40	(1.80, 3.22)***	<0.001
Medication
No	715	120931.17	5.91	1283	121750.3	10.54	1.78	(1.63, 1.95)***	<0.001	1.78	(1.62, 1.95)***	<0.001
Yes	418	55757.85	7.50	737	57873.77	12.73	1.69	(1.50, 1.91)***	<0.001	1.69	(1.50, 1.91)***	<0.001
Metformin
No	973	153820.6	6.33	1715	155900	11.00	1.74	(1.61, 1.88)***	<0.001	1.73	(1.60, 1.87)***	<0.001
Yes	160	22868.41	7.00	305	23724.04	12.86	1.83	(1.51, 2.22)***	<0.001	1.83	(1.51, 2.22)***	<0.001
B-blockers
No	834	140268.18	5.95	1531	142051.16	10.78	1.81	(1.66, 1.97)***	<0.001	1.80	(1.66, 1.96)***	<0.001
Yes	299	36420.84	8.21	489	37572.91	13.01	1.58	(1.37, 1.83)***	<0.001	1.58	(1.37, 1.82)***	<0.001
SSRIs
No	1101	169696.48	6.49	1932	171787.77	11.25	1.73	(1.61, 1.86)***	<0.001	1.72	(1.60, 1.86)***	<0.001
Yes	32	6992.53	4.58	88	7836.31	11.23	2.46	(1.64, 3.69)***	<0.001	2.47	(1.64, 3.70)***	<0.001

PY: person-year; IR: incidence rate, per 1000 person-years; cHR: crude hazard ratio; aHR: adjusted hazard ratio, adjusted for age, comorbidities and medication; CI: confidence interval; *p < 0.05, **p < 0.01, ***p < 0.001.

Table 3b. Cox proportional hazards regression analysis for the risk of postherpetic neuralgia.

Variables	Organic erectile dysfunction						cHR	(95% CI)	p-value	aHR	(95% CI)	p-value
	No			Yes
	n	PY	IR	n	PY	IR
Age, year
20–39	11	32663.87	0.34	12	32932.14	0.36	1.08	(0.48, 2.45)	0.851	1.09	(0.48, 2.47)	0.837
40–59	63	90649.74	0.69	96	95126.08	1.01	1.43	(1.04, 1.96)*	0.029	1.42	(1.04, 1.96)*	0.030
≥60	70	57670.02	1.21	140	62136.87	2.25	1.78	(1.34, 2.38)***	<0.001	1.75	(1.31, 2.33)***	<0.001
Comorbidities
No	70	112042.97	0.62	120	114915	1.04	1.64	(1.22, 2.20)**	0.001	1.62	(1.21, 2.17)**	0.001
Yes	74	68940.66	1.07	128	75280	1.70	1.54	(1.16, 2.05)**	0.003	1.52	(1.14, 2.02)**	0.004
Diabetes Mellitus
No	103	144365.58	0.71	178	150288.31	1.18	1.63	(1.28, 2.07)***	<0.001	1.60	(1.25, 2.03)***	<0.001
Yes	41	36618.05	1.12	70	39906.79	1.75	1.52	(1.03, 2.23)*	0.034	1.45	(0.98, 2.14)	0.060
Chronic kidney disease
No	140	177788.63	0.79	241	186050.28	1.30	1.61	(1.31, 1.99)***	<0.001	1.57	(1.28, 1.94)***	<0.001
Yes	4	3195.00	1.25	7	4144.82	1.69	1.28	(0.37, 4.39)	0.694	1.23	(0.35, 4.30)	0.747
Coronary artery disease
No	108	148213.87	0.73	177	154137.00	1.15	1.55	(1.22, 1.96)***	<0.001	1.51	(1.19, 1.92)***	<0.001
Yes	36	32769.76	1.10	71	36058.09	1.97	1.74	(1.16, 2.60)**	0.007	1.73	(1.16, 2.59)**	0.007
Cancer^$
No	144	180983.63	0.80	248	190195.09	1.29	1.57	(1.28, 1.94)***	<0.001	1.54	(1.25, 1.89)***	<0.001
Yes			0.53			1.95	3.38	(0.74, 15.44)	0.116	3.20	(0.69, 14.85)	0.138
Depression
No	135	168163.40	0.80	218	174926.78	1.25	1.52	(1.23, 1.89)***	<0.001	1.50	(1.21, 1.86)***	<0.001
Yes	9	12820.23	0.70	30	15268.31	1.96	2.69	(1.28, 5.67)**	0.009	2.41	(1.14, 5.10)*	0.021
Medication
No	77	123817.34	0.62	150	128833.9	1.16	1.83	(1.39, 2.41)***	<0.001	1.80	(1.36, 2.36)***	<0.001
Yes	67	57166.29	1.17	98	61361.25	1.6	1.33	(0.97, 1.81)	0.073	1.31	(0.96, 1.79)	0.087
Metformin
No	113	157572.74	0.72	209	164959.71	1.27	1.73	(1.38, 2.18)***	<0.001	1.69	(1.34, 2.13)***	<0.001
Yes	31	23410.89	1.32	39	25235.38	1.55	1.13	(0.71, 1.82)	0.605	1.09	(0.68, 1.75)	0.724
B-blockers
No	99	143624.25	0.69	179	150455.38	1.19	1.69	(1.32, 2.16)***	<0.001	1.65	(1.29, 2.11)***	<0.001
Yes	45	37359.38	1.20	69	39739.72	1.74	1.42	(0.97, 2.06)	0.069	1.39	(0.95, 2.02)	0.088
SSRIs
No	140	173873.86	0.81	233	181996.17	1.28	1.56	(1.26, 1.92)***	<0.001	1.52	(1.23, 1.88)***	<0.001
Yes	4	7109.77	0.56	15	8198.93	1.83	3.22	(1.07, 9.71)*	0.038	2.97	(0.98, 9.04)	0.055

PY: person-year; IR: incidence rate, per 1000 person-years; cHR: crude hazard ratio; aHR: adjusted hazard ratio, adjusted for age, comorbidities and medication; CI: confidence interval; *p < 0.05, **p < 0.01, ***p < 0.001. ^$Owing to the limited number of patients and in adherence to privacy considerations pertaining to personal information, the disclosure of the actual count is precluded.

Data availability statement

The study’s data were sourced from the National Health Insurance Research Database, facilitated by the Taiwan National Health Insurance Administration. Because of the Personal Data Protection Act, public disclosure of the data is restricted. Nevertheless, researchers interested in utilizing the data for research can submit applications for access via the Taiwan National Health Insurance Administration’s website: http://nhird.nhri.org.tw.