Non-Communicable Diseases: Risk Factors and other Health Problems 165 Table 11.1: Prevalence of Probable Benign Prostatic Hyperplasia (BPH) Among Males Aged 40 Years and Above in Malaysia by Socio-Demographic Characteristics (n=2,251) (cont’d) Sociodemographic Characteristics None BPH Probable BPH Count Estimated Population Prevalence (%) 95% CI Count Estimated Population Prevalence (%) 95% CI Lower Upper Lower Upper Household Income Group Less than RM 1,000 173 260,357 81.9 72.92 88.32 40 57,696 18.1 11.68 27.08 RM 1,000 - RM 1,999 386 620,462 82.3 77.36 86.40 93 133,208 17.7 13.60 22.64 RM 2,000 - RM 3,999 573 1,061,821 87.6 83.65 90.73 99 150,081 12.4 9.27 16.35 RM 4,000 - RM 5,999 269 541,984 86.4 81.40 90.19 57 85,459 13.6 9.81 18.60 RM 6,000 - RM 7,999 148 276,300 73.5 62.08 82.39 37 99,825 26.5 17.61 37.92 RM 8,000 - RM 9,999 75 151,995 80.4 65.74 89.75 17 37,083 19.6* 10.25 34.26 RM 10,000 and above 147 283,597 85.4 76.62 91.29 25 48,392 14.6 8.71 23.38 Household Income Quintile Quintile 1 380 553,772 80.7 74.92 85.45 86 132,235 19.3 14.55 25.08 Quintile 2 366 670,011 85.8 81.23 89.37 80 111,116 14.2 10.63 18.77 Quintile 3 350 645,600 87.6 82.29 91.50 61 91,256 12.4 8.50 17.71 Quintile 4 305 615,240 87.0 82.46 90.52 62 91,838 13.0 9.48 17.54 Quintile 5 370 711,892 79.3 72.83 84.63 79 185,300 20.7 15.37 27.17 Household Income Category Bottom 40% 1,219 2,114,427 85.1 82.39 87.42 248 370,824 14.9 12.58 17.61 Middle 40% 398 772,813 80.4 74.10 85.40 94 188,904 19.6 14.60 25.90 Top 20% 154 309,275 85.60 77.22 91.25 26 52,016 14.4 8.75 22.78 *Prevalence with high RSE, interpret with caution a - Malay includes Orang Asli b - Not working includes Unemployed, and Old Age Table 11.2: Association Between BPH Status and Quality of Life (QoL) Due to Urinary Symptom Among Males Aged 40 Years and Above in Malaysia (n=2,251) Variables Good QoL Poor QoL Unweighted Count Estimated Population Prevalence (%) 95% CI Unweighted Count Estimated Population Prevalence (%) 95% CI Lower Upper Lower Upper MALAYSIA 1,810 3,311,510 82.4 79.67 84.76 441 709,465 17.6 15.24 20.33 No BPH 1,644 3,027,119 90.0 87.40 92.09 211 336,798 10.0 7.91 12.60 Probable BPH 166 284,391 43.3 36.74 50.07 230 372,667 56.7 49.93 63.26 *p-value=0.0001
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Non-Communicable Diseases: Risk Factors and other Health Problems 167 Erectile Dysfunction (ED)
National Health and Morbidity Survey 2019 Technical Report − Volume I 168 Erectile Dysfunction (ED) Contributors to this section: Mohamad Fuad Mohamad Anuar, Chong Zhuo Lin, Mohamed Ashraf Mohamed Daud, Shaiful Bahari Ismail, Zakiah Mohd Said, Noor Ani Ahmad, Mohd Shaiful Azlan Kassim, Azli Baharudin, Ridwan Sanaudi Introduction Erectile dysfunction (ED) is defined as the inability to attain and maintain an erect penis enough to allow for satisfactory sexual intercourse [1]. Prevalence of ED reported in previous studies varied widely, ranging from 1.7% in Brazil to 52.0% in United States [2]. In Malaysia, an unpublished nationwide population study conducted in 1998 among men aged 40 years and above reported the overall prevalence of ED at 60.0%, or more specifically mild ED at 44.0% and moderate to severe ED at 16.0% [3]. In view of the rise in non-communicable diseases (NCD) in Malaysia and their association with ED, an update to the current situation of ED among Malaysian men is urgently needed for more equitable health policy planning [4]. Objective To determine the prevalence of erectile dysfunction among sexually active adult males aged 18 years and above in Malaysia. Methods All sexually active adult men age 18 and above were given a self-administered questionnaire on ED. The questionnaire, a 5-item English and Malay versions of the International Index of Erectile Function (IIEF-5), had been previously validated for use in Malaysia [5-7]. Each item in the IIEF-5 assesses a different domain in erectile function, to which respondents could assign a score from 1 to 5, with higher score indicating better function. Total score can range from 5 to 25 and classified as normal (score 22-25), probable mild ED (score 17-21), probable moderate ED (score 8-16) and probable severe ED (score 5-7) [6]. Both probable moderate and severe ED may be more likely to require clinical treatment and were combined together in this report [5-6]. Findings The overall national prevalence of probable moderate to severe ED was 31.6% (95% CI: 28.80, 34.56), as compared to mild ED at 47.1% (95% CI: 43.87, 50.44). There was no large difference between urban and rural strata within moderate to severe ED and mild ED. The prevalence of probable moderate to severe ED appeared to be higher in younger (between 18 to 29 years old) and older age groups (starting at the age of 50 years old), and lower in middle age groups (between 30 to 49 years old). It was also reported to be higher among single people, people with up to primary and secondary education, retiree, students and people who were not working, as well as people in the lowest household income category. On the other hand, the trend observed in probable moderate to severe ED was generally reversed in probable mild ED. The prevalence of probable mild ED was reported to be higher in middle age (between 30 to 49 years old) groups, married persons, and government employees. However, it was found to be rather comparable within education and income sub- groups. Conclusion Our study found that, among sexually active Malaysian men aged 18 and above, 47.1% had probable mild ED and 31.6% had probable moderate to severe ED. The overall prevalence of probable ED was 78.7%. This figure was higher than the 60% reported in 1998 [3]. On top of that, the prevalence of more severe forms of ED also almost doubled. This may be due to the rise in NCD burden over the past two decades. The high prevalence of probable ED among older age groups was expected, but its presence among younger age groups was not. Psychological factors may have contributed to the rise in the prevalence [8]. Among unmarried younger age groups, low self-esteem coupled with unrealistically high expectation in erectile function might be the reason of lower scores observed among them [8]. Nevertheless, part of this low score might be the result of existing organic conditions such as cardiovascular, metabolic, endocrine and neurological diseases, as well as of other psychiatric, psychological, and relational conditions, that must be identified and treated [9].
Non-Communicable Diseases: Risk Factors and other Health Problems 169 In summary, ED is prevalent in Malaysia. Its presence in older age groups must be identified and treated. However, its observation in younger age groups must be interpreted with caution, yet not entirely dismissing its significance. Recommendations These finding indicates an urgent need to address the ED problem in Malaysia. Thus, the following recommendations are made:
- Sexual reproductive health among men especially ED should be prioritized and highlighted.
- More exploration on the preventive and intervention strategy especially in early stage / age to halt progress of NCD and risky lifestyle related to the issue of ED.
- Empowerment of paramedical staff and patient’s self-care are crucial for the success in dealing with ED.
- Education and training programs for ED conditions must be introduced early in the medical curriculum for medical officers and paramedical staff.
- Further research is needed to reveal the factors associated with ED among young people in Malaysia. References
NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. Jama. 1993;270(1):83-90 2. Eardley I. The Incidence, Prevalence, and Natural History of Erectile Dysfunction. Sexual Medicine Reviews. 2013;1(1):3-16. 3. Malaysian Urological Association M. Clinical practice guide in erectile dysfunction 4. Colson MH, Cuzin B, Faix A, Grellet L, Huyghes E. Current epidemiology of erectile dysfunction, an update. Sexologies. 2018;27(1): e7-e13 5. Lim TO, Das A, Rampal S, Zaki M, Sahabudin RM, Rohan MJ, et al. Cross-cultural adaptation and validation of the English version of the International Index of Erectile Function (IIEF) for use in Malaysia. Int J Impotence Res. 2003;15(5):329-36 6. Tang Z, Li D, Zhang X, Yi L, Zhu X, Zeng X, et al. Comparison of the simplified International Index of Erectile Function (IIEF-5) in patients of erectile dysfunction with different pathophysiologies. BMC Urol. 2014; 14:52. 7. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319-26 8. Rynja S, Bosch R, Kok E, Wouters G, De Kort L. IIEF-15: Unsuitable for Assessing Erectile Function of Young Men? The Journal of Sexual Medicine. 2010;7(8):2825-30 9. Rastrelli G, Maggi M. Erectile dysfunction in fit and healthy young men: psychological or pathological? Transl Androl Urol. 2017;6(1):79-90.
National Health and Morbidity Survey 2019 Technical Report − Volume I 170 Table 12.1: Prevalence of Probable Erectile Dysfunction (ED) Among Sexually Active Males Aged 18 Years and Above in Malaysia by Socio-Demographic Characteristics (n=2,403)
Sociodemographic Characteristics Probable Moderate-Severe ED Probable Mild ED Count Estimated Population Prevalence (%) 95% CI Count Estimated Population Prevalence (%) 95% CI Lower Upper Lower Upper MALAYSIA 821 1,744,121 31.6 28.80 34.56 1,081 2,600,942 47.1 43.87 50.44 Location Urban 484 1,356,839 30.6 27.34 34.16 706 2,098,986 47.4 43.49 51.36 Rural 337 387,282 35.5 31.14 40.18 375 501,956 46.1 41.61 50.56 Age Group (Years) 18-19 30 104,734 88.0 70.74 95.67 6 10,712 9.0* 2.70 26.08 20-24 61 208,411 44.7 28.99 61.54 40 207,292 44.5 26.99 63.42 25-29 47 144,901 22.1 15.69 30.10 91 292,691 44.6 34.70 54.89 30-34 42 115,893 14.4 9.25 21.85 123 438,065 54.6 43.60 65.16 35-39 69 203,713 25.5 18.62 33.99 152 361,658 45.4 37.59 53.36 40-44 65 169,316 23.8 17.21 31.92 132 355,175 49.9 41.63 58.19 45-49 59 119,220 21.5 15.34 29.25 150 332,625 60.0 52.09 67.33 50-54 96 161,288 34.6 26.86 43.35 149 255,194 54.8 46.60 62.78 55-59 101 172,280 42.3 34.32 50.76 104 177,465 43.6 35.24 52.35 60-64 89 137,718 53.1 42.57 63.29 81 105,651 40.7 31.01 51.17 65-69 87 123,956 83.2 73.92 89.69 28 23,192 15.6 9.35 24.80 70-74 41 51,986 64.3 45.03 79.77 14 24,471 30.2 16.47 48.81 75 & above 34 30,705 64.7 42.39 82.03 11 16,753 35.3* 17.97 57.61 Ethnicity Malaya 541 914,478 30.9 27.96 33.94 764 1,450,193 48.9 45.92 51.98 Chinese 92 336,753 31.3 23.79 40.01 101 476,819 44.4 34.62 54.56 Indian 54 107,843 34.6 25.43 44.98 59 122,600 39.3 27.56 52.39 Bumiputera Sabah 61 141,530 38.5 30.20 47.43 80 175,122 47.6 39.69 55.59 Bumiputera Sarawak 33 101,808 40.1 30.38 50.67 36 120,177 47.3 32.78 62.37 Others 40 141,709 26.0 15.56 40.00 41 256,031 46.9 30.41 64.09 Marital Status Single 135 444,893 54.0 44.97 62.81 69 236,306 28.7 21.61 37.00 Married 665 1,261,247 27.4 24.64 30.36 984 2,316,335 50.3 46.68 53.99 Widow(er)/Divorcee 21 37,981 41.1 26.39 57.69 28 48,301 52.3 36.05 68.13 Education Level No Formal Education 22 40,300 38.6* 17.84 64.46 10 31,650 30.3* 11.84 58.42 Primary Education 202 358,173 39.1 30.59 48.41 155 414,413 45.3 35.16 55.82 Secondary Education 446 1,009,628 35.5 31.98 39.26 607 1,302,336 45.8 42.18 49.55 Tertiary Education 145 322,249 19.7 15.41 24.72 308 848,802 51.8 44.60 58.86 Occupation Government Employee 66 105,047 16.9 12.20 22.88 199 326,511 52.5 45.02 59.78 Private Employee 281 787,299 29.0 25.06 33.29 462 1,243,614 45.8 41.39 50.31 Self Employed 251 453,211 31.7 25.83 38.18 272 721,695 50.5 42.36 58.53 Unpaid Worker/ Homemaker 9 17,513 28.5* 9.62 59.94 5 36,617 59.7 26.13 86.07 Retiree 103 148,850 51.9 42.06 61.54 72 116,956 40.8 31.23 51.04 Student 13 37,289 71.9 44.71 88.96 7 14,604 28.1* 11.04 55.29 Not Workingb 98 194,912 55.7 43.49 67.19 64 140,944 40.3 29.08 52.53