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Response to: ‘On the approach for determining association between changes in marital quality and cardiovascular disease risk factors’ by MM Pike
  1. Ian Bennett-Britton1,
  2. Alison Teyhan1,
  3. John Macleod1,
  4. Naveed Sattar2,
  5. George Davey Smith1,3,
  6. Yoav Ben-Shlomo1
  1. 1Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  2. 2Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  3. 3MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
  1. Correspondence to Dr Ian Bennett-Britton, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK; ian.bennett-britton{at}

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We thank Ms Pike1 for her interest in our study.

As is highlighted in the Discussion section of our paper,2 we agree that the exclusion of divorced men from our final analyses could have influenced the findings. This is one of many potential sources of bias that we identified in our discussion, including the exclusion of those whose marriages dissolved prior to or during the study, loss to follow-up bias due to participant attrition and the reduced likelihood that wives in poor quality relationships would have asked their partners to attend the follow-up clinic and hence would be missing.

We highlighted these differences in our comparison of baseline covariate data, finding that, ‘as expected, men who were excluded from the analysis were more likely to be poorer, drink more alcohol and have worse marital quality.’ As noted in our discussion, we believe that ‘these biases would systematically attenuate any true relationship so that our observed findings may underestimate the true effect.’ We would not seek to generalise our findings to divorced men as post-divorce risk factors may well change due to different life circumstances, …

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