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Multivariate models were adjusted for age; body mass index; smoking; physical activity; childhood reaction to sun; number of severe sunburns; mole count; hair color; family history of melanoma; sun exposure at high school age and age 25 to 35, 36 to 59, and 60 years or older; UV index at birth and age 15 and 30 years; and other treatments for ED (eMethod 2 [Supplement]). All models were stratified by 2-year intervals, and the main exposure and time-varying covariates were included in the analysis of each follow-up interval. Included covariates are well-defined factors associated with melanoma or sildenafil use. One factor can be a confounder because it changes the effect of the main exposure when included in the model or when included with other covariates.27 In a sensitivity analysis, we also adjusted for history of major chronic diseases (cardiovascular disease, type 2 diabetes mellitus, or hypertension). We evaluated the age-standardized absolute risk associated with sildenafil use.

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