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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Article

State-Level Public Insurance Coverage and Neonatal Circumcision Rates

Mateo Zambrano Navia, Deborah L. Jacobson, Lauren C. Balmert, Ilina Rosoklija, Jane L. Holl, Matthew M. Davis and Emilie K. Johnson
Pediatrics November 2020, 146 (5) e20201475; DOI: https://doi.org/10.1542/peds.2020-1475
Mateo Zambrano Navia
aDepartment of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
bDivisions of Urology and
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Deborah L. Jacobson
bDivisions of Urology and
cDivision of Urology, School of Medicine, The University of Utah, Salt Lake City, Utah; and
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Lauren C. Balmert
dDivision of Biostatistics, Departments of Preventive Medicine,
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Ilina Rosoklija
bDivisions of Urology and
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Jane L. Holl
eSurgery,
fBiological Sciences Division, The University of Chicago, Chicago, Illinois
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Matthew M. Davis
gAcademic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois;
hPediatrics, and
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Emilie K. Johnson
bDivisions of Urology and
iUrology,
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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.

  • Accepted August 17, 2020.
  • Copyright © 2020 by the American Academy of Pediatrics

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Pediatrics
Vol. 146, Issue 5
1 Nov 2020
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State-Level Public Insurance Coverage and Neonatal Circumcision Rates
Mateo Zambrano Navia, Deborah L. Jacobson, Lauren C. Balmert, Ilina Rosoklija, Jane L. Holl, Matthew M. Davis, Emilie K. Johnson
Pediatrics Nov 2020, 146 (5) e20201475; DOI: 10.1542/peds.2020-1475

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State-Level Public Insurance Coverage and Neonatal Circumcision Rates
Mateo Zambrano Navia, Deborah L. Jacobson, Lauren C. Balmert, Ilina Rosoklija, Jane L. Holl, Matthew M. Davis, Emilie K. Johnson
Pediatrics Nov 2020, 146 (5) e20201475; DOI: 10.1542/peds.2020-1475
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