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State-Level Public Insurance Coverage and Neonatal Circumcision Rates.
Pediatrics. 2020 11; 146(5)Ped

Abstract

OBJECTIVES

Seventeen states do not provide Medicaid coverage for neonatal male circumcision, despite American Academy of Pediatrics recommendations supporting access for families that choose it. Our study objectives were to (1) compare state-specific trends in neonatal circumcision to previously established estimates and (2) assess the impact of changes in Medicaid coverage of the procedure.

METHODS

The State Inpatient Databases were used to determine rates of neonatal male circumcision in 4 states (CO, FL, MI, and NY) at 4 time points (2001, 2006, 2011, 2016). Neonatal circumcision was defunded by Medicaid in Florida (2003) and Colorado (2011). A multivariable logistic regression model was created to assess associations between patient and state characteristics and odds of neonatal circumcision.

RESULTS

Overall, 54.5% of neonates underwent circumcision. States where Medicaid defunded neonatal circumcision revealed a decrease in circumcision rates in subsequent years (47.4% to 37.5% in FL; 61.9% to 52.0% in CO). Neonates with private insurance had higher odds of circumcision compared with those with public insurance (adjusted odds ratio [aOR] 2.23; 95% confidence interval [CI] 2.21-2.25). When Medicaid coverage was available, Black neonates had higher odds of circumcision compared with white neonates (aOR 1.44; 95% CI 1.42-1.46). When Medicaid coverage was not available, Black neonates had lower odds compared with white neonates (aOR 0.40; 95% CI 0.39-0.41).

CONCLUSIONS

State-specific data reveal trends in neonatal circumcision similar to previous national estimates. Colorado and Florida revealed 20.9% and 16.0% reductions in neonatal circumcision rates, respectively, after defunding. Black neonates appeared to be disproportionately affected by changes in Medicaid coverage.

Authors+Show Affiliations

Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Divisions of Urology and.Divisions of Urology and. Division of Urology, School of Medicine, The University of Utah, Salt Lake City, Utah; and.Division of Biostatistics, Departments of Preventive Medicine.Divisions of Urology and.Surgery. Biological Sciences Division, The University of Chicago, Chicago, Illinois.Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Pediatrics, and.Divisions of Urology and ekjohnson@luriechildrens.org. Urology.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33055226

Citation

Zambrano Navia, Mateo, et al. "State-Level Public Insurance Coverage and Neonatal Circumcision Rates." Pediatrics, vol. 146, no. 5, 2020.
Zambrano Navia M, Jacobson DL, Balmert LC, et al. State-Level Public Insurance Coverage and Neonatal Circumcision Rates. Pediatrics. 2020;146(5).
Zambrano Navia, M., Jacobson, D. L., Balmert, L. C., Rosoklija, I., Holl, J. L., Davis, M. M., & Johnson, E. K. (2020). State-Level Public Insurance Coverage and Neonatal Circumcision Rates. Pediatrics, 146(5). https://doi.org/10.1542/peds.2020-1475
Zambrano Navia M, et al. State-Level Public Insurance Coverage and Neonatal Circumcision Rates. Pediatrics. 2020;146(5) PubMed PMID: 33055226.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - State-Level Public Insurance Coverage and Neonatal Circumcision Rates. AU - Zambrano Navia,Mateo, AU - Jacobson,Deborah L, AU - Balmert,Lauren C, AU - Rosoklija,Ilina, AU - Holl,Jane L, AU - Davis,Matthew M, AU - Johnson,Emilie K, Y1 - 2020/10/14/ PY - 2020/08/17/accepted PY - 2020/10/16/pubmed PY - 2020/10/16/medline PY - 2020/10/15/entrez JF - Pediatrics JO - Pediatrics VL - 146 IS - 5 N2 - OBJECTIVES: Seventeen states do not provide Medicaid coverage for neonatal male circumcision, despite American Academy of Pediatrics recommendations supporting access for families that choose it. Our study objectives were to (1) compare state-specific trends in neonatal circumcision to previously established estimates and (2) assess the impact of changes in Medicaid coverage of the procedure. METHODS: The State Inpatient Databases were used to determine rates of neonatal male circumcision in 4 states (CO, FL, MI, and NY) at 4 time points (2001, 2006, 2011, 2016). Neonatal circumcision was defunded by Medicaid in Florida (2003) and Colorado (2011). A multivariable logistic regression model was created to assess associations between patient and state characteristics and odds of neonatal circumcision. RESULTS: Overall, 54.5% of neonates underwent circumcision. States where Medicaid defunded neonatal circumcision revealed a decrease in circumcision rates in subsequent years (47.4% to 37.5% in FL; 61.9% to 52.0% in CO). Neonates with private insurance had higher odds of circumcision compared with those with public insurance (adjusted odds ratio [aOR] 2.23; 95% confidence interval [CI] 2.21-2.25). When Medicaid coverage was available, Black neonates had higher odds of circumcision compared with white neonates (aOR 1.44; 95% CI 1.42-1.46). When Medicaid coverage was not available, Black neonates had lower odds compared with white neonates (aOR 0.40; 95% CI 0.39-0.41). CONCLUSIONS: State-specific data reveal trends in neonatal circumcision similar to previous national estimates. Colorado and Florida revealed 20.9% and 16.0% reductions in neonatal circumcision rates, respectively, after defunding. Black neonates appeared to be disproportionately affected by changes in Medicaid coverage. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/33055226/State_Level_Public_Insurance_Coverage_and_Neonatal_Circumcision_Rates_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=33055226 DB - PRIME DP - Unbound Medicine ER -