The effect of comorbidities and socioeconomic status on sexual and urinary function in men undergoing prostate cancer screening

Introduction. Comorbidities and socioeconomic status (SES) represent known confounders of baseline health-related quality of life. Aim. To assess the effect of comorbidities and of SES variables on urinary function (UF) and sexual function (SF) and on associated bother items. Methods. A cohort of 1,162 men without an established diagnosis of prostate cancer (PCa) completed questionnaires addressing SES characteristics, the lifetime prevalence of 12 comorbid conditions, SF and UF as well as their associated bother. Main Outcome Measures. Crude and adjusted logistic regression models tested the association between the predictors, SES and comorbidity, and four separate outcomes, namely SF and UF and their associated bother. Results. Of all men, aged 40-79 years, 172 (14.8%) reported poor or very poor ability to have an erection, and for 165 (14.2%), erectile function (EF) was a big or moderate problem. Daily or weekly urinary incontinence was reported by 98 (8.4%) men, and for 94 (8.1%) men, UF was a big or moderate problem. One or more comorbidities were present in 437 (37.6%) men. In age- and SES-adjusted analyses, major depression and diabetes had the most detrimental effect on EF (5.8 [P < 0.001] and 4.8 [P < 0.001], respectively) and on sexual bother (4.3 [P < 0.001] and 7.2 [P < 0.001], respectively). Stroke (4.7 [P = 0.004]) and drug problems (4.8 [P = 0.002]) had the most detrimental effect on urinary incontinence. Alcoholism and alcohol-related problems (3.1 [P = 0.004]) had the most detrimental effect on the urinary bother scale. Finally, SES only affected urinary incontinence, which was poorer in men who lived with a spouse or partner (2.1 [P = 0.03]). Conclusion. Select comorbidities have very strong effects on UF and EF. Conversely, for most SES variables, the effect was weak and insignificant. In consequence, when patients are assessed for definitive PCa therapy, comorbidities require an adjustment, whereas SES assessment may potentially be omitted, especially if questionnaire brevity is a consideration.