{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:01:52Z","timestamp":1787022112871,"version":"build-2736575974"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:00:00Z","timestamp":1665964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Although circumcision is the most commonly performed surgery in males, less is known about the incidence and indications of adult circumcision. In this study, we aim to present the incidence of adult circumcision across the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using IBM MarketScan\n                      <jats:sup>\u00ae<\/jats:sup>\n                      Commercial Database from 2015 to 2018, we obtained claims for circumcision in men between 18 and 64 years of age. We calculated the incidence of adult circumcision over the study period and across the United States. We also collected data on indications for surgery using International Classification of Diseases codes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified a total of 12,298 claims for adult circumcisions. The mean age was 39 (\u00b112.9) years. The average incidence rates remained relatively constant from 98.1 per 100,000 person-years in 2015 to 98.2 per 100,000 person-years in 2018 (\u0394+0.1%). The age-standardized incidence rates varied significantly across the United States (from 0 to 194.8 per 100,000 person-years) with South Dakota having the highest rate. The most common indications for adult circumcision were phimosis (52.5%), routine\/ritual circumcision (28.7%), phimosis + balanitis\/balanoposthitis (6.8%), balanitis (3.8%) and balanoposthitis (2.6%), and significantly varied by age groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study suggested a wide geographic variation in rates of adult circumcision between states with highest incidences in the Northeast United States. Future studies can identify the underlying causes for the observed variations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0275207","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T13:31:41Z","timestamp":1666013501000},"page":"e0275207","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Incidence of circumcision among insured adults in the United States"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4378-9243","authenticated-orcid":true,"given":"Behnam","family":"Nabavizadeh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0550-0250","authenticated-orcid":true,"given":"Kevin D.","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nizar","family":"Hakam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5710-9299","authenticated-orcid":true,"given":"Nathan M.","family":"Shaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Leapman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin N.","family":"Breyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,10,17]]},"reference":[{"issue":"1","key":"pone.0275207.ref001","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1370\/afm.1073","article-title":"Safety and efficacy of nontherapeutic male circumcision: a systematic review","volume":"8","author":"CL Perera","year":"2010","journal-title":"Ann Fam Med"},{"key":"pone.0275207.ref002","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12963-016-0073-5","article-title":"Estimation of country-specific and global prevalence of male circumcision","volume":"14","author":"BJ Morris","year":"2016","journal-title":"Popul Health Metr"},{"issue":"3","key":"pone.0275207.ref003","doi-asserted-by":"crossref","first-page":"e756","DOI":"10.1542\/peds.2012-1990","article-title":"Male circumcision","volume":"130","year":"2012","journal-title":"Pediatrics"},{"key":"pone.0275207.ref004","unstructured":"Circumcision\u2014American Urological Association. https:\/\/www.auanet.org\/guidelines\/guidelines\/circumcision Accessed August 15, 2021."},{"issue":"2","key":"pone.0275207.ref005","first-page":"8204","article-title":"Indications for adult circumcision: a contemporary analysis","volume":"23","author":"M Siev","year":"2016","journal-title":"Can J Urol"},{"issue":"1","key":"pone.0275207.ref006","doi-asserted-by":"crossref","first-page":"E15","DOI":"10.1503\/cmaj.109-4013","article-title":"Late cuts: an international look at adult circumcision","volume":"184","author":"R. Collier","year":"2012","journal-title":"Cmaj"},{"issue":"11","key":"pone.0275207.ref007","doi-asserted-by":"crossref","first-page":"e298","DOI":"10.1371\/journal.pmed.0020298","article-title":"Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial","volume":"2","author":"B Auvert","year":"2005","journal-title":"PLoS Med"},{"issue":"9562","key":"pone.0275207.ref008","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/S0140-6736(07)60313-4","article-title":"Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial","volume":"369","author":"RH Gray","year":"2007","journal-title":"Lancet"},{"issue":"9","key":"pone.0275207.ref009","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/j.cmi.2016.07.030","article-title":"Pros and cons of circumcision: an evidence-based overview","volume":"22","author":"B Friedman","year":"2016","journal-title":"Clin Microbiol Infect"},{"issue":"5","key":"pone.0275207.ref010","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1111\/and.12101","article-title":"Adult circumcision and male sexual health: a retrospective analysis","volume":"46","author":"J Dias","year":"2014","journal-title":"Andrologia"},{"issue":"5","key":"pone.0275207.ref011","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1016\/S0022-5347(05)65098-7","article-title":"Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction","volume":"167","author":"KS Fink","year":"2002","journal-title":"J Urol"},{"issue":"6","key":"pone.0275207.ref012","doi-asserted-by":"crossref","first-page":"2237","DOI":"10.1016\/j.juro.2012.12.062","article-title":"How painful is adult circumcision? A prospective, observational cohort study","volume":"189","author":"BP Rai","year":"2013","journal-title":"J Urol"},{"issue":"3","key":"pone.0275207.ref013","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1111\/j.1464-410X.2006.06646.x","article-title":"The effect of male circumcision on sexuality","volume":"99","author":"D Kim","year":"2007","journal-title":"BJU Int"},{"issue":"1","key":"pone.0275207.ref014","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1097\/JU.0000000000001316","article-title":"Nationwide Circumcision Trends: 2003 to 2016","volume":"205","author":"DL Jacobson","year":"2021","journal-title":"J Urol"},{"key":"pone.0275207.ref015","unstructured":"IBM MarketScan Research Databases for Health Services Researchers (White Paper), IBM Watson Health\u00ae. https:\/\/www.ibm.com\/downloads\/cas\/6KNYVVQ2 Accessed August 15, 2021."},{"key":"pone.0275207.ref016","article-title":"Trends in circumcision for male newborns in US hospitals: 1979\u20132010","author":"M Owings","year":"2013","journal-title":"National Center for Health Statistics"},{"key":"pone.0275207.ref017","article-title":"nc-est2020-agesex-res: Annual Estimates of the Resident Population by Single Year of Age and","volume":"1","author":"US Census Bureau","year":"2010","journal-title":"Sex for the United States"},{"issue":"6","key":"pone.0275207.ref018","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1097\/EDE.0b013e3181577511","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration","volume":"18","author":"JP Vandenbroucke","year":"2007","journal-title":"Epidemiology"},{"issue":"7","key":"pone.0275207.ref019","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1097\/01.OLQ.0000430797.56499.0d","article-title":"Prevalence of circumcision among men and boys aged 14 to 59 years in the United States, National Health and Nutrition Examination Surveys 2005\u20132010","volume":"40","author":"CE Introcaso","year":"2013","journal-title":"Sex Transm Dis"},{"key":"pone.0275207.ref020","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.urology.2019.10.003","article-title":"Prevalence of Phimosis in Males of All Ages: Systematic Review","volume":"135","author":"BJ Morris","year":"2020","journal-title":"Urology"},{"issue":"5","key":"pone.0275207.ref021","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1097\/00006254-200405000-00026","article-title":"Neonatal circumcision: a review of the world\u2019s oldest and most controversial operation","volume":"59","author":"MC Alanis","year":"2004","journal-title":"Obstet Gynecol Surv"},{"key":"pone.0275207.ref022","author":"Newborn Fetus AAoPCo","year":"1971","journal-title":"Standards and recommendations for hospital care of newborn infants: American Academy of Pediatrics"},{"issue":"7","key":"pone.0275207.ref023","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1097\/01.olq.0000253335.41841.04","article-title":"Prevalence of circumcision and herpes simplex virus type 2 infection in men in the United States: the National Health and Nutrition Examination Survey (NHANES), 1999\u20132004","volume":"34","author":"F Xu","year":"2007","journal-title":"Sex Transm Dis"},{"key":"pone.0275207.ref024","volume-title":"Health insurance coverage in the United States: 2018","author":"ER Berchick","year":"2019"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0275207","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T13:31:59Z","timestamp":1666013519000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0275207"}},"subtitle":[],"editor":[{"given":"James","family":"Mockridge","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,10,17]]},"references-count":24,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0275207","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,17]]}}}