Early childhood circumcision in Australia: Trends over 20 years and interrupted time series analysis

Abstract

Background Male circumcision is one of the most common surgical procedures performed in the Australian private sector. This study examines the trends in childhood circumcision throughout the early 21st century. Methods Circumcisions performed between 2000 and 2019 amongst preschool‐aged Australian boys (0–4 years) were obtained from the Medicare Benefits Schedule. Quarterly data for Victoria and South Australia were divided into three phases separated by (i) state‐wide bans of non‐therapeutic circumcision in the public sector (2007) and (ii) a disfavouring of non‐therapeutic circumcisions by the Royal Australasian College of Physicians (2010). Interrupted time series analyses determined differences between pre‐ban (2000–2007), post‐ban (2007–2010) and reversal (2010–2019) phases. Results Altogether, 478 717 circumcisions were performed on preschool‐aged boys. Incidence progressed from 2675 per 100 000 preschoolers in 2000 to 3140 in 2008 to 1875 in 2019. In Victoria, the baseline (Q1‐2000) rate of circumcision was 294.9 per 100 000. This rose by +1.3 (1.1 to 4.1, p < 0.001) per quarter pre‐ban and +6.6 (3.0 to 10.3, p = 0.001) post‐ban before decreasing by −13.1 (−16.4 to −9.8, p < 0.001) in the reversal phase. In South Australia, the initial rate was 745.2 per 100 000 and increased by +1.4 (0.0 to 2.8, p = 0.045) per quarter pre‐ban, +7.6 (0.5 to 14.7, p = 0.035) post‐ban and retracted by −20.8 (−27.9 to −13.7, p < 0.001) during the reversal phase. Conclusion The incidence of childhood circumcisions in Australia observed a significant rise and fall throughout the early 21st century. Medical and surgical authorities may have played an important role in the gradual reduction of procedures over the last decade.

Neonatal Male Circumcision: Clearly Beneficial for Public Health or an Ethical Dilemma? A Systematic Review

“…This would include multiple cases for some individuals and none for others. In Australia, conversely, if there was an increase in the prevalence of NMC from the level of 19% in 2019 [132] to 90%, it has been calculated that this would result in approximately 77,000 fewer cases of adverse medical conditions over the lifetime of the 2019 annual male birth cohort of 157,000 [131]. #Based on data for circumcised vs. uncircumcised males [112,128,150,151].…”

Evidence-based circumcision policy for Australia

“…A 2021 study of Medical Benefits Scheme (MBS) claims found that early MC in Australia declined from a peak of ~85% in the 1950s to 18.75% in 2019 [ 8 ]. The authors concluded that “Medical and surgical authorities may have played an important role in the gradual reduction of procedures over the last decade”.…”

“…In Australia and New Zealand, the lack of government coverage for non-therapeutic MC in public health systems would similarly be having cost impacts for treatment of medical conditions protected against by neonatal MC. An increase in early MC in Australia to 85% from the current level of 18.75% [ 8 ] would avoid 77,000 cases of infections and other adverse medical conditions over the lifetime for each annual birth cohort ( Table 1 ).…”

“…It is mostly seen in uncircumcised boys. (8) Penoscrotal webbing in when the skin of the scrotum is attached to the underside of the shaft. Apart from abnormal cosmetic appearance it does not cause functional problems.…”

“…In Australia, a 2010 telephone survey found that 33% of Australian men under 30 years of age were circumcised [ 7 ]. Recent data show a reduction in early MC prevalence from a peak of 85% in the 1950s to 18.75% in 2019 [ 8 ]. In the US, Centers for Disease Control and Prevention (CDC) estimates show an increasing trend in MC prevalence to 92% in white, 76% in black and 44% of Hispanic males aged 14–59 years [ 9 ].…”