Agency News and Numbers

Two new reports from the Nationwide Inpatient Sample (NIS) are available from the Agency for Healthcare Research and Quality (AHRQ). The first reflects the widely varying rates of circumcision around the United States, and the second contains updated data on epilepsy hospitalizations.

The NIS is a database of hospital inpatient stays that is nationally representative of inpatient stays in all short-term, non-Federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured.

The reports, Circumcision Performed in U.S. Community Hospitals, 2005, Statistical Brief #45, and Hospitalizations for Epilepsy and Convulsions, 2005, Statistical Brief #46, are summarized below and are available online along with other reports at http://www.hcup-us.ahrq.gov/reports/statbriefs.jsp.

Circumcision rates are highest in the Midwest and lowest in the West

Rates of circumcision vary widely across the nation, a phenomenon likely linked to regional variations in racial, ethnic, and immigrant populations, as well as insurance coverage. >Circumcision is the surgical removal of foreskin from the penis of an infant boy. The operation is usually performed for cultural, religious, or cosmetic reasons rather than for medical reasons. Some organizations, including the American Academy of Pediatrics, maintain there is insufficient evidence that routine circumcision is medically necessary. However, there is research suggesting that some health benefits may be gained, including a slightly decreased risk of developing penile cancer, a lower chance of urinary tract infections in newborns, and a potentially lessened risk of HIV transmission.

AHRQ's new report is an analysis of hospital-based circumcisions in 2005. Among its findings: In the West, only 31 percent of newborn boys were circumcised in hospitals in 2005. That compares with 75 percent in the Midwest, 65 percent in the Northeast, and 56 percent in the South. Factors influencing circumcision rates may include immigration from Latin America and other areas, where circumcision is less common, and insurance coverage.

Nationwide, about 56 percent of newborn boys—1.2 million infants—were circumcised. The national rate has remained relatively stable for a decade. It peaked at 65 percent in 1980. About 60 percent of circumcisions were billed to private insurance, 31 percent were billed to Medicaid, nearly 3 percent were charged to other public programs, and about 4 percent were uninsured.

Epilepsy hospitalizations rise after an 8-year decline

Epilepsy-related hospitalizations, which fell from 176,000 in 1993 to 95,000 in 2000, climbed to 136,000 in 2005. The recent 5-year climb represented a 43 percent increase. Epilepsy, a condition characterized by recurrent seizures that may include repetitive muscle jerking called convulsions, affects 1 to 2 percent of the U.S. population. AHRQ's analysis also showed:

• Nearly two-thirds of the patients hospitalized with epilepsy between 2000 and 2005 were younger than 45.
• Between 1993 and 2005, convulsion-related hospitalizations increased 69 percent from 730,000 to 1.2 million. Patients 65 and older were more than twice as likely as younger people to be hospitalized with convulsions.

Although epilepsy can cause convulsions, the vast majority of these convulsion cases were not epilepsy related but were rather caused by fever, stroke, infection, uremia—blood poisoning caused by kidney failure—high or low blood sugar, low blood sodium levels, and substance abuse and withdrawal.

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