Response to: ‘On the approach for determining association between changes in marital quality and cardiovascular disease risk factors by MM Pike

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…

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