Determinants and policy implications of male circumcision in the United States.
OBJECTIVE
We sought to determine whether lack of state Medicaid coverage for infant male circumcision correlates with lower circumcision rates.


METHODS
We used data from the Nationwide Inpatient Sample on 417 282 male newborns to calculate hospital-level circumcision rates. We used weighted multiple regression to correlate hospital circumcision rates with hospital-level predictors and state Medicaid coverage of circumcision.


RESULTS
The mean neonatal male circumcision rate was 55.9%. When we controlled for other factors, hospitals in states in which Medicaid covers routine male circumcision had circumcision rates that were 24 percentage points higher than did hospitals in states without such coverage (P<.001). Hospitals serving greater proportions of Hispanic patients had lower circumcision rates; this was not true of hospitals serving more African Americans. Medicaid coverage had a smaller effect on circumcision rates when a hospital had a greater percentage of Hispanic births.


CONCLUSIONS
Lack of Medicaid coverage for neonatal male circumcision correlated with lower rates of circumcision. Because uncircumcised males face greater risk of HIV and other sexually transmitted infections, lack of Medicaid coverage for circumcision may translate into future health disparities for children born to poor families covered by Medicaid.
Leibowitz
Arleen A
AA
Department of Public Policy, UCLA School of Public Affairs, Box 951656, Los Angeles, CA 90095-1656, USA. arleen@ucla.edu
Desmond
Katherine
K
Belin
Thomas
T
D000704:Analysis of Variance; D002944:Circumcision, Male / Q000191:economics / Q000706:statistics & numerical data*; D019992:Databases as Topic; D006291:Health Policy / Q000191:economics*; D054624:Health Status Disparities; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D011634:Public Health / Q000191:economics / Q000706:statistics & numerical data; D012044:Regression Analysis; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology