摘要：Objective. We sought to determine whether lack of state Medicaid coverage for infant male circumcision correlates with lower circumcision rates. Methods. We used data from the Nationwide Inpatient Sample on 417 282 male newborns to calculate hospital-level circumcision rates. We used weighted multiple regression to correlate hospital circumcision rates with hospital-level predictors and state Medicaid coverage of circumcision. Results. The mean neonatal male circumcision rate was 55.9%. When we controlled for other factors, hospitals in states in which Medicaid covers routine male circumcision had circumcision rates that were 24 percentage points higher than did hospitals in states without such coverage ( P < .001). Hospitals serving greater proportions of Hispanic patients had lower circumcision rates; this was not true of hospitals serving more African Americans. Medicaid coverage had a smaller effect on circumcision rates when a hospital had a greater percentage of Hispanic births. Conclusions. Lack of Medicaid coverage for neonatal male circumcision correlated with lower rates of circumcision. 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. Three recent randomized clinical trials in South Africa, Kenya, and Uganda found that male circumcision reduces a man's risk of becoming infected with HIV through contact with a female partner by 55% to 76%. 1 – 3 These results are consistent with meta-analyses based on observational studies in Africa 4 , 5 and the United States. 6 , 7 The recent randomized clinical trial findings prompted the American Academy of Pediatrics (AAP) to form a committee in June 2007 to review its position on male circumcision. 8 In 1999 the AAP had adopted a neutral stance, stating that the medical benefits were not compelling enough to recommend routine neonatal circumcision. In the wake of the AAP statement, several states withdrew Medicaid coverage for routine, nontherapeutic circumcision. Currently, 16 state Medicaid plans do not cover the procedure. In 2006, legislators in Hawaii and Vermont introduced resolutions challenging the need for state funding of routine male circumcision. 9 In view of the striking results from the African clinical trials, it is timely to examine the impact of US hospital- and state-level policies on domestic rates of male circumcision. In particular, we hypothesized that male circumcision rates would be higher in states in which the Medicaid program pays for routine circumcision.
