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Longitudinal Sociodemographic Analysis of Operative Circumcisions at Children's Hospitals
Hans C Arora1, Matthew Hall2, Ilina Rosoklija1
1Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Insights
The number of post-neonatal circumcisions in US children's hospitals nearly doubled between 2004 and 2018. This trend suggests emerging healthcare disparities, with increased rates among non-Hispanic Black boys and those of lower socioeconomic status.
Area of Science:
- Pediatric Surgery
- Health Disparities Research
- Urology
Background:
- Neonatal circumcision access shows established sociodemographic disparities.
- Post-neonatal operative circumcision trends in children's hospitals are not well-characterized.
- Understanding these trends is crucial for addressing potential healthcare inequities.
Purpose of the Study:
- To characterize elective, post-neonatal operative circumcision procedures in US children's hospitals.
- To examine sociodemographic factors associated with these procedures.
- To identify potential emerging healthcare disparities in circumcision access.
Main Methods:
- Retrospective cohort study using data from 23 Pediatric Health Information System (PHIS) hospitals (2004-2018).
- Included boys undergoing elective operative circumcision; excluded those aged >= 36 months or with penile congenital anomalies.
- Compared circumcision cohort to a referent cohort undergoing other ambulatory surgery or observational stays using bivariate statistics.
Main Results:
- The annual median number of operative circumcisions per hospital significantly increased (P = .003).
- Circumcision cohort demographics: 46.7% non-Hispanic White, 30.9% non-Hispanic Black, 26.6% lowest income quartile, 51.5% Southern US, 60.5% publicly insured.
- Compared to referent cohort, circumcision patients were more likely non-Hispanic Black (30.9% vs 15.7%, P = .001) and publicly insured (60.5% vs 45.9%, P = .001).
Conclusions:
- Post-neonatal operative circumcisions nearly doubled in US children's hospitals from 2004-2018.
- Findings suggest emerging healthcare disparities.
- Non-Hispanic Black boys and those of lower socioeconomic status are undergoing more expensive, higher-risk post-neonatal circumcisions.
Objective:
To characterize elective, post-neonatal operative circumcision at US children's hospitals, in the context of established sociodemographic disparities in access to neonatal circumcision.
Methods:
A retrospective cohort study was performed of boys undergoing elective, operative circumcision at the 23 Pediatric Health Information System (PHIS) hospitals who contributed data from 2004-2018. Boys > = 36 months' and those with congenital anomalies of the penis were excluded. Bivariate statistics were used to compare the circumcision cohort to a referent cohort of boys undergoing other ambulatory surgery or having an observational hospital stay.
Results:
The annual median number of operative circumcisions per hospital increased during the study (72 [IQR 54-162] to 136 [IQR 88-266], P = .003). Boys undergoing circumcision were mostly non-Hispanic White (46.7%) or non-Hispanic Black (30.9%), in the lowest income quartile (26.6%), from the Southern US (51.5%), and publicly-insured (60.5%). When compared to the reference cohort, boys undergoing circumcision were more likely to be non-Hispanic Black (30.9 vs 15.7%, P = .001) and publicly-insured (60.5 vs 45.9%, P = . 001).
Conclusion:
The number of post-neonatal operative circumcisions performed at US children's hospitals nearly doubled from 2004 to 2018. Study findings suggest an emerging healthcare disparity, with non-Hispanic Black boys of lower socioeconomic status undergoing more post-neonatal operative circumcisions that are more expensive and higher risk.
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