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Longitudinal Sociodemographic Analysis of Operative Circumcisions at Children's Hospitals

      Abstract

      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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      References

      1. HCUP Fast Stats. Healthcare Cost and Utilization Project (HCUP) www.hcup-us.ahrq.gov/faststats/landing.jsp.

        • Dalin JR
        • Madeleine MM
        • Johnson LG
        • Schwartz SM
        • Shera KA
        • Wurscher MA
        • et al.
        Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease.
        Int J Cancer. 2005; 116: 606-616
        • Homfray V
        • Tanton C
        • Miller RF
        • Beddows S
        • Field N
        • Sonnenberg P
        • et al.
        Male Circumcision and STI acquisition in britain: evidence from a national probability sample survey.
        PLoS One. 2015; 10e0130396
        • Leibowitz AA
        • Desmond K
        • Belin T
        Determinants and policy implications of male circumcision in the United States.
        Am J Public Health. 2009; 99: 138-145
        • El Bcheraoui C
        • Zhang X
        • Cooper CS
        • Rose CE
        • Kilmarx PH
        • Chen RT
        Rates of adverse events associated with male circumcision in U.S. medical settings, 2001 to 2010.
        JAMA Pediatr. 2014; 168: 625-634
        • Horowitz M
        • Gershbein AB
        Gomco circumcision: When is it safe?.
        J Pediatr Surg. 2001; 36: 1047-1049
        • Rappaport BA
        • Suresh S
        • Hertz S
        • Evers AS
        • Orser BA
        Anesthetic neurotoxicity–clinical implications of animal models.
        N Engl J Med. 2015; 372: 796-797
        • Introcaso CE
        • Xu F
        • Kilmarx PH
        • Zaidi A
        • Markowitz LE
        Prevalence of circumcision among men and boys aged 14 to 59 years in the United States, National Health and Nutrition Examination Surveys 2005-2010.
        Sex Transm Dis. 2013; 40: 521-525
        • Otto R
        • Evans G
        • Boniquit C
        • Peppas D
        • Leslie J
        Why desired newborn circumcisions are not performed: a survey.
        Urology. 2016; 97: 188-193
        • Hart-Cooper GD
        • Tao G
        • Stock JA
        • Hoover KW
        Circumcision of privately insured males aged 0 to 18 years in the United States.
        Pediatrics. 2014; 134: 950-956
        • Schoen EJ
        • Colby CJ
        • To TT
        Cost analysis of neonatal circumcision in a large health maintenance organization.
        J Urol. 2006; 175: 1111-1115
        • Warner L
        • Cox S
        • Whiteman M
        • Jamieson DJ
        • Macaluso M
        • Bansi P
        • et al.
        Impact of Health insurance type on trends in newborn circumcision, united states, 2000 to 2010.
        Am J Public Health. 2015; 105: 1943-1949
        • Gutwein LG
        • Alvarez JF
        • Gutwein JL
        • Kays DW
        • Islam S
        Allocation of healthcare dollars: analysis of nonneonatal circumcisions in Florida.
        Am Surg. 2013; 79: 865-869
        • Zambrano Navia M
        • Jacobson DL
        • Balmert LC
        • Rosoklija I
        • Holl JL
        • Davis MM
        • Johnson EK
        State-level public insurance coverage and neonatal circumcision rates.
        Pediatrics. 2020;
        • Jacobson DL
        • Balmert LC
        • Holl JL
        • Rosoklija I
        • Davis MM
        • Johnson EK
        Nationwide circumcision trends: 2003 to 2016.
        J Urol. 2021; 205: 257-263