Determinants and Policy Implications of Male Circumcision in the United States

The authors' objective was to establish whether not having state Medicaid coverage for infant male circumcision is associated with lower circumcision rates.

To calculate hospital-level circumcision rates, the researchers used data from the Nationwide Inpatient Sample on 417,282 male newborns. Weighted multiple regression was used to correlate hospital circumcision rates with hospital-level predictors and state Medicaid coverage of circumcision.

The mean neonatal male circumcision rate was 55.9 percent. After controlling for other factors, the investigators found that hospitals in states where Medicaid covers routine male circumcision had circumcision rates that were 24 percentage points higher than hospitals in states without this coverage (p<.001). In addition, hospitals that had greater proportions of Hispanic patients had lower circumcision rates; this was not true of hospitals that served more African-American patients. Medicaid coverage had less of an effect on circumcision rates in hospitals with a greater percentage of Hispanic births.

"Lack of Medicaid coverage for neonatal male circumcision correlated with lower rates of circumcision," the authors concluded. "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."

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