Determinants and policy implications of male circumcision in the United States

Abstract

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.

FIGURE 1

Predicted neonatal male circumcision rates as a function of Medicaid coverage of circumcision and the percentage of male newborns in hospital for whom Medicaid is their primary payer: Nationwide Inpatient Sample, 2004.

FIGURE 2

Predicted neonatal male circumcision rates as a function of Medicaid coverage of circumcision and percentage of births that are Hispanic: Nationwide Inpatient Sample, 2004.