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Letter
Response to Mansoor et al: ‘epidemiology of inflammatory bowel disease in men with high-risk homosexual activity’
  1. Kira L Newman1,
  2. Kara Jencks1,
  3. Victor Chedid2,
  4. Sonali Paul3,
  5. Peter D R Higgins1,
  6. Sunanda V Kane2,
  7. Millie Long4
  1. 1 Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA
  2. 2 Medicine, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Medicine, The University of Chicago Medicine, Chicago, Illinois, USA
  4. 4 Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Kira L Newman, University of Michigan, Ann Arbor MI 48103, Michigan, USA; kinewman{at}med.umich.edu

http://dx.doi.org/10.1136/gutjnl-2022-328802

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    We were interested to read the letter by Mansoor et al, ‘epidemiology of inflammatory bowel disease (IBD) in men with high-risk homosexual activity’,1 which was in response to the two recently published studies by Agrawal et al 2 and Cha et al.3 However, we would like to point out significant methodological flaws in their design and analysis.

    The data used have the potential to misclassify both the exposure and outcomes. The authors inferred sexual behaviours from billing codes, which is not included in the best practices outlined in the 2022 National Academies report on this topic.4 Sexual orientation and sexual behaviour may be misclassified or subject to significant selection bias when relying on billing codes. Up to 97% of sexual minority individuals with documentation in clinic notes of sexual orientation and/or sexual practices do not have identifying billing codes in their records.5 The imbalance in the prevalence of billing …

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    Footnotes

    • Twitter @KiraNewmanMDPhD, @KaraJencks

    • Contributors KLN, VC, KC, SP and PDRH contributed substantially to the conception and design of the work. All authors contributed to the analysis and interpretation. PDRH, SVK, SP and ML contributed substantially to the critical revision of the work. All authors were involved in drafting the work. All authors provided final approval for submission.

    • Funding KLN is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number F32DK134043.

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The content of this letter is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    • Competing interests ML received consulting fees from AbbVie, Janssen, Takeda, Pfizer, Lilly, Genentech, Roche, Prometheus, BMS and Target Pharmasolutions. PDRH received consulting fees from AbbVie, Amgen, Genentech, JBR Pharma and Lycera. SVK received consulting fees from BMS, Boehringer Ingelheim, Gilead, InveniAI, Janssen, Predictamed, and Seres Therapeutics, Takeda, TechLab, and United Healthcare. SP received funding from Intercept Pharmaceuticals, Target Pharmasolutions and Genfit. All other authors report no disclosures.

    • Provenance and peer review Not commissioned; externally peer reviewed.