Presentation Authors: Deborah L. Jacobson*, Jane L. Holl, Timothy B. Lautz, Ilina Rosoklija, Emilie K. Johnson, Chicago, IL
Introduction: Among some populations, access to neonatal circumcision (NC) has become increasingly limited, despite evidence that benefits justify NC access and reimbursement. This study aims to examine national trends in NC before and after the 2011 American Academy of Pediatrics (AAP) recommendation for NC reimbursement.
Methods: A retrospective cohort study of boys aged â‰¤ 28 days was conducted using data from the 2003, 2006, 2009, 2012, and 2016 Kids&[prime] Inpatient Database. Boys who underwent NC prior to discharge were compared to boys who did not. Boys with coagulopathies or penile anomalies were excluded.
Results: An estimated 8,851,629 boys were included in the final cohort. Boys were primarily Caucasian (53.5%), privately insured (48.8%), and cared for at large (61.1%), urban, teaching (50.3%) hospitals in metropolitan areas (56.4%). More than half (4,776,015 [54.0%]) underwent NC prior to hospital discharge (Table 1). Caucasian (64.7%) or African-American (65.8%) boys, boys in the highest income quartile (59.7%), and boys in the midwest (73.6%) were most likely to undergo NC (Table 2). NC rates decreased significantly over time (p < 0.001), with relative between-group differences remaining largely stable over time (Figure 1). In a multivariate regression, NC was more common among privately (63.7%) than publicly (43.9%) insured boys, even when controlling for demographics, hospital characteristics, and year (p < 0.001).
Conclusions: Among ~8.8 million boys, sampled over 13 years, 54.0% underwent NC. The rate of neonatal circumcision varies widely by region of the country, race, and socioeconomic factors. Decreasing rates of NC over the past 15 years are likely multifactorial, related to changing demographic trends and parental preference, but also indicative of access issues for patients with public insurance even after the 2011 AAP recommendations.