P3.189: Temporal Trends Among Hispanic Ethnicity and Male Circumcision: A Population Based Cohort Study

Background: Male circumcision (MC) is associated with many health benefits including lowering risks of urinary tract infections, sexually transmitted diseases, and penile cancer. MC rates are influenced by cultural beliefs, healthcare access, economics, regional customs, and other social factors. This study explores the association between Hispanic ethnicity and MC rates in newborn males in Texas, accounting for insurance type, racial subgroup, and geographic region.

Methods: A retrospective population-based cohort study was conducted utilizing the Texas Inpatient Public Use Data File (TIPUDF) over the period 2016 through 2023. Male newborn admissions were identified using the type of admission and sex code columns of the TIPUDF. The primary exposure was Hispanic ethnicity and the primary outcome was in-hospital circumcision. International Classification of Diseases, Tenth Revisions, Procedure Coding System (ICD-10-PCS) codes corresponding to male circumcision were identified using Clinical Classification Software Refined (CCSR) category MRS001: Male reproductive system procedures; Circumcision Fisher’s test was applied to measure the association of Hispanic ethnicity and circumcision. Subgroup analyses include type of insurance, race, and public health region. Negative binomial regression was applied to measure the time trend in circumcision rates overall, for non-Hispanics, and for Hispanics. Differences in circumcision rates are reported as standardized mean difference (SMD) and p value. Time trends are reported as annual percentage change and 95% confidence interval.

Results: A total of 1,454,960 newborn male admissions were identified of which 549,016 (37.7%) were Hispanic. Compared to non-Hispanics, Hispanics were less often of Black race (1.8% vs 17.9%) and less often Asian or Pacific Islander (0.8% vs 7.2%). Hispanics less often had private insurance (31.3% vs 53.9%). Differences in diagnoses of Newborn affected by maternal conditions or complications of labor/delivery and congenital conditions and anomalies were not practically significant between Hispanics and non-Hispanics. Overall, circumcision rates were over two-fold lower in Hispanics (28.4% vs 60.1%; SMD = 0.6746, p < 0.0001). The results of subgroup analysis showed consistency of the association across all examined subgroups except for Asian or Pacific Islander race (42.7% vs 43.9%; SMD = 0.0236, p = 0.1273). The rate of circumcision fell during the study period overall from 49.3% in 2016 to 44.5% in 2023 (APC -1.6 [95% CI -2.2 to -1.0]), among non-Hispanics from 66.5% in 2016 to 60.9% in 2023 (APC -4.1[95% CI -7.6 to -0.5]), and among Hispanics from 27.0% in 2016 to 24.9% in 2023 (APC -1.1[95% CI -1.7 to -0.5]).

Conclusion: A persistent and consistent disparity in MC rates between non-Hispanics and Hispanics exists in Texas with the overall rates of MC falling over the most recent decade. Additional studies may identify rates of urinary track infections and penile cancer across populations and explore impacts of insurance coverage, cultural norms, and other factors on parental decision making.