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

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.