Neonatal circumcision in US hospitals declined from 54% in 2012 to 49% in 2022, according to a national analysis of inpatient records. The estimated number of procedures fell from nearly 1 million to about 816,000 during a 10-year period, despite recommendations from major health organizations that recognize neonatal circumcision reduces penile inflammation, urinary tract infections, and acquisition and transmission of sexually transmitted infections. Specifically, the World Health Organization advised neonatal circumcision in 2007, followed by the American Academy of Pediatrics in 2012 and the Centers for Disease Control and Prevention in 2018.
Researchers analyzed more than 1.8 million male neonatal hospitalizations in 2012 and nearly 1.7 million in 2022 and found that the Midwest reported the highest prevalence of neonatal circumcision at 69% while the West recorded the lowest at 20%. The decline was most evident among White patients, in whom prevalence decreased from 65% in 2012 to 60% in 2022. Prevalence among Black patients remained stable near 65%, and prevalence among Hispanic patients stayed near 21%. Native American patients had a decline from 44% in 2012 to 41% in 2022. Prevalence of the procedure in those whose race was categorized as “other” decreased from 49% to 43%. Regional differences persisted when combined with race: prevalence among White patients in the West declined from 34% in 2012 to 26% in 2022.
Socioeconomic differences were also apparent. Patients from the highest-income ZIP code quartiles and those covered by private insurance had higher circumcision prevalence but also the largest declines. Prevalence among privately insured patients decreased from 64% to 56%. Among Medicaid-covered patients, prevalence declined from 45% to 42%. The authors of the analysis noted that 17 states had ended Medicaid coverage for routine neonatal circumcision by 2011, which created barriers for families with low income. They also suggested that continual Hispanic population growth—the group with the lowest circumcision prevalence—may contribute to overall decreases. They wrote that their findings align with prior trends and "reflect sociodemographic changes."
The researchers analyzed data from the Kids’ Inpatient Database for 2012, 2016, 2019, and 2022. Male neonates aged 0 to 28 days were included. Patients with coagulopathies, penile anomalies, or prematurity were excluded. Circumcisions were identified through International Classification of Diseases codes. Discharges, not individual patients, served as the unit of analysis, and survey weights were applied to estimate national prevalence.
The study had several limitations. Only inpatient procedures were captured, excluding outpatient circumcisions and likely underestimating overall prevalence. Use of administrative codes may have introduced misclassification. State identifiers were not available, which limited regional analysis. Because discharges rather than unique patients were counted, multiple hospitalizations for a single patient could not be excluded.
Aaron A. R. Tobian, MD, PhD, of the Department of Pathology at Johns Hopkins University School of Medicine, and colleagues explained, “Although the AAP affirms that NMC benefits outweigh the risks and supports access to the procedure, it recommends leaving the decision to parents. There is also increased skepticism toward medical recommendations in the US.”
Full disclosures can be found in the study.
Source: JAMA Pediatrics
