Trends in pediatric circumcision in Belgium and the Brussels University Hospital from


Attachments Attachment 1: Permission of the Ethical Comitee of the Brussels University Hospital to perform this study



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Attachments

Attachment 1: Permission of the Ethical Comitee of the Brussels University Hospital to perform this study




Attachment 2: Estimating the 2008 catchment area of the Brussels University Hospital

Data of the Brussels Capital Region


Municipality

Wa

P

Wi

CP

CA?

JETTE

8790

44601

7760.574

50517.24138

113.2648178

BRUSSEL

11,019

148873

25903.902

63327.58621

42.53799292

ST-J-MOLENBEEK

7266

83674

14559.276

41758.62069

49.90632776

GANSHOREN

4651

21743

3783.282

26729.88506

122.9355887

ST-A-BERCHEM

2681

20976

3649.824

15408.04598

73.45559676

ANDERLECHT

2481

99085

17240.79

14258.62069

14.39029186

KOEKELBERG

2305

19020

3309.48

13247.12644

69.64840398

SCHAARBEEK

2108

116039

20190.786

12114.94253

10.44040584

ELSENE

803

79768

13879.632

4614.942529

5.785455983

EVERE

665

34727

6042.498

3821.83908

11.00538221


Wa = number of persons admitted in the Brussels University Hospital

P = population of the municipality

Wi = total number of persons of the municipality admitted in any hospital. This number was calculated based on the 2008 national Health Survey. 17.4% of the population of the Brussels Capital Region was hospitalized in the year 2008



CP = catchment population

CA? = percentage of the population of the municipality included in the catchment population of the Brussels University Hospital. If this number is 25 or higher, the municipality is included in the catchment area

XX = Municipalities included in the catchment area of the Brussels University Hospital


Data of Flanders


Municipality

Wa

P

Wi

CP

CA?

VILVOORDE

3,964

38,557

7557.172

20224.4898

52.45348392

WEMMEL

3,699

14,916

2923.536

18872.44898

126.5248658

DILBEEK

5,228

39,654

7772.184

26673.46939

67.26552022

GRIMBERGEN

5,510

34,526

6767.096

28112.2449

81.42340525

ASSE

3,556

29,558

5793.368

18142.85714

61.38053029

MERCHTEM

1,717

15,110

2961.56

8760.204082

57.97620173

MEISE

2,770

18,466

3619.336

14132.65306

76.53337518

LONDERZEEL

1,392

17,525

3434.9

7102.040816

40.52519724

HALLE

1,637

35,350

6928.6

8352.040816

23.62670669

SINT-PIETERS-LEEUW

1,456

31,119

6099.324

7428.571429

23.87149789

OPWIJK

820

12,575

2464.7

4183.673469

33.26976914

ZAVENTEM

653

29,500

5782

3331.632653

11.29367001

BUGGENHOUT

446

13,973

2738.708

2275.510204

16.2850512

LIEDEKERKE

489

12,206

2392.376

2494.897959

20.43993085

TERNAT

759

14,781

2897.076

3872.44898

26.19882944

LENNIK

439

8,747

1714.412

2239.795918

25.60644699

AFFLIGEM

396

12,229

2396.884

2020.408163

16.52145035

OVERIJSE

489

24,394

4781.224

2494.897959

10.2275066

KAPELLE-OP-DEN-BOS

416

8,969

1757.924

2122.44898

23.66427673

STEENOKKERZEEL

478

11,201

2195.396

2438.77551

21.77283734

GOOIK

312

8,931

1750.476

1591.836735

17.82372338

BEERSEL

942

23,587

4623.052

4806.122449

20.37614978


Wa = number of persons admitted in the Brussels University Hospital

P = population of the municipality

Wi = total number of persons of the municipality admitted in any hospital. This number was calculated based on the 2008 national Health Survey. 19.6% of the population of Flanders was hospitalized in the year 2008



CP = catchment population

CA? = percentage of the population of the municipality included in the catchment population of the Brussels University Hospital. If this number is 25 or higher, the municipality is included in the catchment area

XX = Municipalities included in the catchment area of the Brussels University Hospital

Estimating the 2008 catchment area of the Brussels University Hospital using the Norris-Bailey proportionate flow method





  1. Estimating the catchment population in a reporting year

The catchment population was estimated using the following formula:


CPax = ∑ (Wax x Pa /(∑ Wai))
CPax = Catchment population of hospital ‘x’ in municipality ‘a’ in the reporting year

Wax = Number of persons admitted in hospital ‘x’ living in municipality ‘a’ in the reporting year

Pa = Population of municipality ‘a’ in the reporting year

Wai = Total number of persons living in municipality ‘a’ that are hospitalized in the reporting year




  1. Estimating the catchment area

The proportion of the catchment population of the total population of the municipality was calculated. If this proportion is 25% or higher, the municipality is included in the catchment area.


CAx? = (CPax /Pa)/100
CAx = Is the municipality included in the catchment area of hospital ‘x’ ?

CPax = Catchment population of hospital ‘x’ in municipality ‘a’ in the reporting year

Pa = Population of municipality ‘a’ in the reporting year
NOTE: In Wemmel, Jette and Ganshoren the catchment population is greater than the population of the municipality. This is due to an overestimation of the number of persons admitted in the Brussels University Hospital. The number of admissions in the Brussels University Hospital was based on anonymous data; only the municipality of the admitted person was noted. Therefore a person who was admitted twice in an according year was accounted as 2 persons. Consequently some of the municipalities that are included in the catchment area of the Brussels University Hospital are not part of the actual catchment area. The number of pediatric circumcisions performed in the Brussels University Hospital was not compared with the number of boys aged between 0 and 15 years in each municipality of the catchment area, as there were not enough data to do so. This number was compared with the number of boys aged between 0 and 15 years in the Brussels Capital Region and Flemish Brabant and in these regions there are other municipalities that are also not part of the catchment area.

Attachment 3: Estimating the yearly total number of circumcisions in Belgium of boys aged 0 to 15 years from 2002 to 2005





  1. Calculation of the mean circumcision rate of males of 16 years and older from the year 2006 to 2011

Year

MYE of males ≥ 16 years

Number of circumcision of males ≥16 years

Circumcision rate (/1000 males ≥16 years /year)

2006

4177365.5

4755

1.138277

2007

4216525.5

4937

1.170869

2008

4257021.5

4952

1.163255

2009

4294585.5

5152

1.19965

2010

4335778

5085

1.1728

2011

4376229

5141

1.17476

MCR







1.16993


MYE of males ≥ 16 years = the mid-year estimate of males of 16 years and older. The yearly numbers were obtained from the Belgian National Institute for Statistics and the Research Department of the Flemish Government.63,64

The mid-year estimate was calculated using the following formula:

population year A + ( (population year A + population year B) / 2 )

Number of circumcision of males ≥16 years = this number was provided by the National Institute for Health and Disability Insurance (NIHDI or RIZIV)

The circumcision rate was calculated by dividing the number of circumcisions of males ≥ 16 years by the mid-year estimate of males ≥ 16 years

MCR = the mean circumcision rate. This was calculated dividing the sum of the yearly circumcision rates by the total number of years (6).



  1. Extrapolation of the mean circumcision rate of males of 16 years and older to the year 2002 to 2005, calculation of the yearly total number of circumcisions in that age group and calculation of the yearly total number of circumcisions of boys aged between 0 and 15 years from 2002 to 2005




Year

MYE of males ≥ 16 years

Number of circumcision of males ≥16 years

Total

number of circumcisions

Number of circumcisions of males <16 years

2002

4083639

4777.571775

17794

13016.42822

2003

4104608

4802.104037

18116

13313.89596

2004

4129193

4830.866766

18872

14041.13323

2005

4159310

4866.101548

19419

14552.89845


MYE of males ≥ 16 years = the mid-year estimate of males of 16 years and older. This was estimated with the following formula:

population year A + ( (population year A + population year B) / 2 )



Number of circumcision of males ≥16 years = this number was calculated by multiplying the mid-year estimate of males of 16 years and older with the mean circumcision rate

Total number of circumcisions = this number was provided by the National Institute for Health and Disability Insurance (NIHDI or RIZIV)

The number of circumcisions of males <16 years was calculated by subtracting the total number of circumcisions with the number of circumcision of males ≥16 years

References


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* Penile lichen sclerosis (also termed balanitis xerotica obliterans) is a progressive inflammatory disorder of the skin that can lead to phimosis. It is the main cause of acquired phimosis and the treatment of choice is complete circumcision. (Becker K. Lichen sclerosus in boys. Deutsches Ärzteblatt International 2011. 108(4):53-58)


Dana Van Gassen



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