title: Impact of Health Insurance Type on Trends in Newborn Circumcision, United States, 2000 to 2010.
abstract: OBJECTIVE
  We explored how changes in insurance coverage contributed to recent nationwide decreases in newborn circumcision.
  
  
  METHODS
  Hospital discharge data from the 2000-2010 Nationwide Inpatient Sample were analyzed to assess trends in circumcision incidence among male newborn birth hospitalizations covered by private insurance or Medicaid. We examined the impact of insurance coverage on circumcision incidence.
  
  
  RESULTS
  Overall, circumcision incidence decreased significantly from 61.3% in 2000 to 56.9% in 2010 in unadjusted analyses (P for trend = .008), but not in analyses adjusted for insurance status (P for trend = .46) and other predictors (P for trend = .55). Significant decreases were observed only in the South, where adjusted analyses revealed decreases in circumcision overall (P for trend = .007) and among hospitalizations with Medicaid (P for trend = .005) but not those with private insurance (P for trend = .13). Newborn male birth hospitalizations covered by Medicaid increased from 36.0% (2000) to 50.1% (2010; P for trend < .001), suggesting 390,000 additional circumcisions might have occurred nationwide had insurance coverage remained constant.
  
  
  CONCLUSIONS
  Shifts in insurance coverage, particularly toward Medicaid, likely contributed to decreases in newborn circumcision nationwide and in the South. Barriers to the availability of circumcision should be revisited, particularly for families who desire but have less financial access to the procedure.
authors.affiliation: All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Lee
authors.initials: L
authors.lastname: Warner
authors.affiliation: All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Shanna
authors.initials: S
authors.lastname: Cox
authors.affiliation: All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Maura
authors.initials: M
authors.lastname: Whiteman
authors.affiliation: All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.affiliation: All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Macaluso
authors.affiliation: All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Pooja
authors.initials: P
authors.lastname: Bansil
authors.affiliation: All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Elena
authors.initials: E
authors.lastname: Kuklina
authors.affiliation: All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Athena P
authors.initials: AP
authors.lastname: Kourtis
authors.affiliation: All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Posner
authors.affiliation: All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Wanda D
authors.initials: WD
authors.lastname: Barfield
mesh_terms: D002944:Circumcision, Male / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D014481:United States