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Nationwide Circumcision Trends: 2003-2016

Jacobson, D. L.; Balmert, L. C.; Holl, J. L.; Rosoklija, I.; Davis, M. M.; Johnson, E. K.

J Urol. 2020 Jul 28; 101097ju0000000000001316

Abstract

OBJECTIVE: Among some populations, access to neonatal circumcision has become increasingly limited despite evidence of its benefits. This study examines national neonatal circumcision trends before and after the 2012 American Academy of Pediatrics recommendation for neonatal circumcision reimbursement. METHODS: A retrospective cohort study of boys aged ≤28 days was conducted using data from the Kids' Inpatient Database (2003-2016). Boys who underwent neonatal circumcision prior to discharge were compared to boys who did not. Boys with coagulopathies, penile anomalies, or a history of prematurity were excluded. RESULTS: An estimated 8,038,289 boys comprised the final cohort. Boys were primarily white (53.7%), privately insured (49.1%), and cared for at large (60.8%) teaching (49.4%) hospitals in metropolitan areas (84.1%). While 55.0% underwent circumcision prior to discharge, neonatal circumcision rates decreased significantly over time (p<0.0001). Black (68.0%) or white (66.0%) boys, boys in the highest income quartile (60.7%), and Midwestern boys (75.0%) were most likely to be circumcised. Neonatal circumcision was significantly more common among privately (64.9%) than publicly (44.6%) insured boys after controlling for demographics, region, hospital characteristics, and year (p<0.0001). The odds of circumcision over time was not significantly different in the years before versus after 2012 (p=0.28). CONCLUSIONS: Among approximately 8 million boys sampled over a 13-year period, 55.0% underwent neonatal circumcision. The rate of neonatal circumcision varied widely by region, race, and socioeconomic status. The finding that boys with public insurance have lower circumcision rates in all years may be related to lack of circumcision access for boys with public insurance.

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