Nationwide Circumcision Trends: 2003 to 2016

Area of Science:

• Pediatric Health
• Public Health Trends
• Medical Economics

Background:

• Access to neonatal circumcision has declined in some populations, despite documented benefits.
• The American Academy of Pediatrics (AAP) issued a recommendation regarding neonatal circumcision reimbursement in 2012.

Purpose of the Study:

• To examine national trends in neonatal circumcision rates before and after the 2012 AAP recommendation.
• To identify demographic and socioeconomic factors influencing neonatal circumcision rates.

Main Methods:

• Retrospective cohort study using the Kids' Inpatient Database (2003-2016).
• Analysis of over 8 million male neonates, comparing those circumcised before discharge to those not.
• Exclusion of infants with coagulopathies, penile anomalies, or prematurity.

Main Results:

• Overall neonatal circumcision rate was 55.0%, showing a significant decrease over the study period (p <0.0001).
• Circumcision rates varied significantly by region, race, and socioeconomic status.
• Privately insured boys had higher circumcision rates (64.9%) compared to publicly insured boys (44.6%) (p <0.0001).
• No significant difference in circumcision rates was observed before versus after the 2012 AAP recommendation (p=0.28).

Conclusions:

• Neonatal circumcision rates have declined, with disparities observed across different demographic groups.
• Lower circumcision rates among publicly insured boys may indicate access barriers related to insurance coverage.
• Further research is needed to understand and address the factors contributing to decreased access and utilization.