OBJECTIVES: Erectile dysfunction (ED) prevalence and burden of illness can vary according to geography, time, and methodologies. The current study examined health-related quality of life (HRQoL) and productivity impairments associated with varying ED severity and associated risk factors. METHODS: Data on adult men (40-70 years old) were analyzed from the 2016 National Health and Wellness Survey in Brazil, China, France, Germany, Italy, Spain, United Kingdom, and United States. Men with ED were selected on the basis of self-reporting any difficulty achieving/maintaining an erection in the past six months, and this measure was also used to define four levels of ED severity (mild, moderate, moderate/severe, and severe). Men with benign prostatic hyperplasia (BPH) were excluded. HRQoL measures included Mental and Physical Component Summary scores (MCS and PCS, respectively) derived from the SF-36v2, as well as SF-6D health utility scores. Work Productivity and Activity Impairment questionnaire-based measures were also included. Generalized linear models analyzed each outcome as a function of ED severity and risk factors, controlling for country, demographics, health characteristics and behaviors, and Charlson comorbidity index scores. RESULTS: Among 24,100 men with ED, moderate, moderate/severe, and severe ED were associated with significantly more negative MCS (-1.86, -3.67, and -4.38, respectively), PCS (-1.42, -2.94, and -4.45), and health utilities (-0.023, -0.049, and -0.064), and higher absenteeism (1.38, 2.16, and 2.53 times the rate, respectively), presenteeism (1.33, 1.84, and 1.94), overall work impairment (1.32, 1.85, and 1.94), and activity impairment (1.29, 1.66, and 1.75) than those with mild ED (all p<.001). The presence vs. absence of other comorbid conditions (depression, diabetes, obesity, smoking, and hypertension) was also associated with poorer outcomes; statistical significance varied by condition. CONCLUSIONS: Among 40-70 year-old men with ED, severity and comorbidities such as smoking, depression, and hypertension were associated with poorer health outcomes globally.