{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T21:11:55Z","timestamp":1793308315920,"version":"4.5.0"},"reference-count":29,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["#81971821"],"award-info":[{"award-number":["#81971821"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Mens Health"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    This study investigates the association between the hemoglobin-to-red blood cell distribution width ratio (HRR) and erectile dysfunction (ED), a prevalent male sexual health concern. Analyzing data from 2,197 participants in the National Health and Nutrition Examination Survey (2001\u20132004), we employed logistic regression models and restricted cubic spline analysis to examine this relationship while conducting comprehensive sensitivity and subgroup analyses. Of the participants, 725 individuals reported ED history. Regression analysis revealed a significant inverse relationship between HRR levels and ED likelihood, with fully adjusted models showing a 69% reduced ED risk per HRR unit increase (odds ratio [\n                    <jats:italic toggle=\"yes\">OR<\/jats:italic>\n                    ] = 0.31, 95% confidence interval [CI] = [0.12, 0.77],\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = .016). Tertile analysis demonstrated progressive ED risk reduction across ascending HRR categories in all models: Model 1 (\n                    <jats:italic toggle=\"yes\">OR<\/jats:italic>\n                    = 0.29, 95% CI = [0.23, 0.37],\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; .001), Model 2 (\n                    <jats:italic toggle=\"yes\">OR<\/jats:italic>\n                    = 0.58, 95% CI = [0.43, 0.82],\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = .003), and Model 3 (\n                    <jats:italic toggle=\"yes\">OR<\/jats:italic>\n                    = 0.66, 95% CI = [0.45, 0.97],\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = .035). Restricted cubic spline analysis confirmed linear association patterns without significant nonlinearity (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &gt; .05). Sensitivity analyses reinforced HRR\u2019s consistent negative correlation with ED risk, whereas subgroup analyses revealed stable associations across demographic strata without significant interaction effects. Our findings identify reduced HRR as an independent risk factor for ED, suggesting its potential utility as a clinical biomarker for early ED detection and prevention strategies. This novel hematological parameter could enhance risk stratification and inform interventions to mitigate disease progression and recurrence, potentially improving therapeutic outcomes in male sexual health management.\n                  <\/jats:p>","DOI":"10.1177\/15579883251414645","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T10:32:03Z","timestamp":1768386723000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Hemoglobin-to-Red Blood Cell Distribution Width Ratio and Erectile Dysfunction Among U.S. Adults: A Moderated Mediation Analysis of Body Roundness Index"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2580-7218","authenticated-orcid":false,"given":"Yumei","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Emergency, The First Hospital of China Medical University, Shenyang City, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaling","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Emergency, The First Hospital of China Medical University, Shenyang City, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5269-6383","authenticated-orcid":false,"given":"Xuesong","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Emergency, The First Hospital of China Medical University, Shenyang City, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"crossref","unstructured":"Ali A. 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