U.S. Neonatal Circumcision Rates Among Commercially Insured Persons, 2005

Background:
Male circumcision has been associated with decreased female-to-male transmission of HIV infection. Circumcision is also associated with other health benefits, including a decreased risk of sexually transmitted diseases, penile cancer, and urinary tract infection. Compared to post-neonatal circumcision, neonatal circumcision has fewer complications and lower costs. Estimates of the rate of neonatal circumcision provide a baseline for estimating the potential impact of expanding the practice as a disease prevention intervention, but current estimates of the rate are limited and based on surveys.

Objective:
The objective of this study is to provide an estimate of the rate of neonatal circumcision in the United States in 2005 among commercially-insured persons.

Method:
To measure circumcision rates, we used the MarketScan database (Thomson Corporation, Stamford, CT), which contains insurance claims data for 14 million commercially-insured persons. The number of male births and the number of neonatal circumcision procedures were determined by using counts of insurance claims in 2005 with birth- and circumcision-related Current Procedures Terminology (CPT) codes. Rates were calculated for the commercially-insured population, both overall and by region (northeast, midwest, south, and west).

Result:
The overall male neonatal circumcision rate was 64%. It was 67% in the northeast; 71% in the midwest; 63% in the south; and 57% in the west. The northeast, south, and west differed significantly from the midwest (p < 0.05).

Conclusion:
Our findings show that infant circumcision rates are high in the United States. Rates were highest in the midwest and lowest in the west. These findings are largely consistent with published surveys, but we found higher rates among commercially-insured persons in the west than previously reported.

Implications:
Accurate estimates of male circumcision rates are necessary for modeling and cost-effectiveness studies of circumcision as an intervention in the prevention of HIV and STD.