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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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  • Contributors For original referenced manuscript, IB-B co-conceived research question, cleaned data, co-wrote and performed statistical analysis, interpreted data, drafted and revised paper. IB-B drafted and revised response to letter to editor. He is guarantor. For original referenced manuscript, AT co-wrote statistical analysis plan, interpreted data, drafted and revised paper. AT, JM, NS and GDS reviewed and approved response to letter to editor. For original referenced manuscript, JM drafted, revised paper and is a co-director of the ALSPAC project. For original referenced manuscript, NS drafted and revised paper and was responsible for blood biomarker measurements used. For original referenced manuscript, GDS drafted, revised original paper and secured funding to maintain ALSPAC data collection and the resource. For original referenced manuscript, YB-S organised the data collection for the Focus on Fathers clinic, co-conceived original research question, co-wrote statistical analysis plan, supported the data analysis, drafted and revised paper. YB-S drafted, reviewed and approved response to letter to editor. This publication is the work of the authors and IB-B will serve as guarantor for the contents of this paper.

  • Funding The UK Medical Research Council and the Wellcome Trust (Grant ref: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. GDS works within the Medical Research Council Integrative Epidemiology Unit at the University of Bristol (MC_UU_12013/1). IB-B is an Academic Clinical Fellow in Primary Care funded by the National Institute of Health Research (ACF-2014-25-008). Funding bodies had no influence over the content of this manuscript.

  • Competing interests None declared.

  • Patient consent Not required.

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

  • Data sharing statement A fully searchable Avon Longitudinal Study of Parents and Children (ALSPAC) data dictionary is available online. Sharing of ALSPAC data is encouraged and facilitated for all researchers from all disciplines across the world to maximise use of the resource. For more information on data applications, please see the ALSPAC website.

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