Association between Long-Term Ambient Air Pollution and Erectile Dysfunction in Taiwan: A Nationwide Cohort Study

Background: Erectile dysfunction (ED) is a prevalent condition with important vascular and systemic implications. Although air pollution has been linked to multiple chronic diseases, its association with ED remains insufficiently explored. Objectives: To investigate the association between long-term exposure to multiple ambient air pollutants and the risk of ED among Taiwanese men. Materials and Methods: We conducted a retrospective nationwide cohort study using the National Health Insurance Research Database from 2000 to 2013. Ten-year cumulative exposures to 11 pollutants—sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), particulate matter <10 µm (PM10), particulate matter <2.5 µm (PM2.5), nitrogen oxides (NOX), nitrogen monoxide (NO), nitrogen dioxide (NO2), total hydrocarbons (THC), nonmethane hydrocarbons (NMHC), and methane (CH4)—were estimated by linking residential postal codes. The outcome was incident ED (Ninth Revision of the International Classification of Diseases, Clinical Modification 302.72 or 607.84). Cox regression models adjusted for demographics, comorbidities, medications, ambient temperature, season, and short-term pollutant levels were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Results: During follow-up, 4936 participants (1.16%) developed ED. Each 1-SD increase in SO2, CO, O3, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 was associated with increased ED risk (adjusted HRs 1.45–2.65; p < 0.001 for all). Conversely, O3 exposure was inversely associated with ED (HR 0.45; 95% CI 0.44–0.46). These associations remained consistent across age strata. Discussion: Our findings suggest that chronic exposure to most ambient air pollutants may contribute to ED, potentially through vascular, endocrine, and inflammatory pathways, while O3 may exhibit paradoxical protective effects. Conclusions: Long-term exposure to multiple air pollutants is associated with an elevated risk of ED among Taiwanese men, highlighting air pollution as a potential modifiable environmental risk factor for men's sexual health.