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We thank Newman et al1 for the interest in our recent letter2; however, we strongly disagree with the statement that our work has ‘significant methodological flaws’. First, in regard to inference of sexual behaviour from billing codes, we would like to point out that prior studies have used these codes to analyse administrative datasets.3 We acknowledge the possibility of biases inherent to large database studies that use the electronic health record (EHR), including the potential for misdiagnoses, inaccurate coding and documentation errors. However, administrative claims documenting sexual orientation are coded by clinicians, the diagnoses relying on provision of patient-derived information and providers’ decisions, which can also be impacted by failure to divulge sexual activity, and may represent an important potential limitation for future prospective studies that should obviously be performed to either support or negate the current …
Contributors Study conception and design: EM and FC. Acquisition of data: EM and AP. Analysis and Interpretation: EM, SAM, AP, SG, FC. Drafting of manuscript: EM, SAM, AP and FC. Critical Revision: EM, VQN, JAK, SG and FC. Study supervision: EM,VQN, JAK and FC.
Funding This work was supported by the Clinical Component of the Administrative Core of the NIH Cleveland Digestive Diseases Research Core CenterCentre, DK097948 and administrative supplement DK097948-08S1 from NIDDK and SGMRO.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.