University of Illinois College of Medicine, Chicago, USA.
Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.
BMC Urol. 2021 Oct 27;21(1):148. doi: 10.1186/s12894-021-00911-7.
A significant proportion of boys present to surgical specialists later in infancy/early childhood for elective operative circumcision despite the higher procedural risks. This study aims to assess physician perspectives on access to neonatal circumcision across the United States and identify potential reasons contributing to disparities in access.
A cross-sectional survey was electronically distributed to physician members of the Societies for Pediatric Urology and the American Academy of Pediatrics Section on Hospital Medicine. Hospital characteristics and circumcision practices were assessed. Associations between NC availability and institutional characteristics were evaluated using chi-squared testing and multivariable logistic regression. Qualitative analyses of free-text comments were performed.
A total of 367 physicians responded (129 urologists [41%], 188 pediatric hospitalists [59%]). Neonatal circumcision was available at 86% of hospitals represented. On univariate and multivariate analysis, the 50 hospitals that did not offer neonatal circumcision were more likely to be located in the Western region (odds ratio [OR] = 8.33; 95% confidence interval [CI] 3.1-25 vs. Midwest) and in an urban area (OR = 4.2; 95% CI 1.6-10 vs. suburban/rural) compared with hospitals that offered neonatal circumcision. Most common reasons for lack of availability included not a birth hospital (N = 22, 47%), lack of insurance coverage (N = 8, 17%), and low insurance reimbursement (N = 7, 15%). Institutional, regional, or provider availability (68%), insurance/payment (12.4%), and ethics (12.4%) were common themes in the qualitative comments.
Overall availability of neonatal circumcision varied based on hospital characteristics, including geography. Information from this survey will inform development of interventions designed to offer neonatal circumcision equitably and comprehensively.
尽管手术风险较高，但仍有相当比例的男孩在婴儿期/幼儿期后期由外科专家进行选择性手术割礼。本研究旨在评估美国各地医生对新生儿割礼的看法，并确定导致获得机会不平等的潜在原因。
对小儿泌尿科协会和美国儿科学会医院医学科的医生成员进行了横断面调查。评估了医院特征和割礼实践。使用卡方检验和多变量逻辑回归评估 NC 可用性与机构特征之间的关联。对自由文本评论进行了定性分析。
共有 367 名医生做出了回应（129 名泌尿科医生[41%]，188 名儿科医院医生[59%]）。在所代表的医院中，86%的医院提供新生儿割礼。在单变量和多变量分析中，未提供新生儿割礼的 50 家医院更有可能位于西部地区（优势比[OR] = 8.33；95%置信区间[CI] 3.1-25 与中西部地区）和城市地区（OR = 4.2；95% CI 1.6-10 与郊区/农村地区）与提供新生儿割礼的医院相比。缺乏可用性的最常见原因包括不是分娩医院（N=22，47%）、缺乏保险覆盖（N=8，17%）和低保险报销（N=7，15%）。机构、区域或提供者的可用性（68%）、保险/付款（12.4%）和伦理（12.4%）是定性评论中的常见主题。
基于医院特征（包括地理位置），新生儿割礼的总体可用性存在差异。这项调查的信息将为制定旨在公平和全面提供新生儿割礼的干预措施提供信息。
