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reader that the presented comparisons were sound. Furthermore, Figures 2 and 3 display gradients in the estimated hazard ratios by marital status. Given the low number of observed deaths in some of these categories (e.g. 187 deaths among women in present or previous same-sex marriage), and thereby limited statistical power, this is to be expected. Nevertheless, the hazard ratios are presented with quite narrow confidence intervals (Table 2). Is it possible that there is some kind of statistical dependency in the dataset that is not accounted for in the analysis? Many factors come into play in a dataset like this. In particular, we have not been able to locate information explaining how correlations between same-sex married individuals were accounted for. Every same-sex married individual has a close connection with at least one other individual in the same category, contributing correlations between pairs of observations. A similar problem does not occur for opposite-sex married individuals, since men and women are analysed separately. Frisch and Simonsen have approached important health concerns, addressing how living arrangements were linked with overall cause-specific mortality, and they present alarming conclusions. This includes increased mortality rates for same-sex married individuals compared with opposite-sex married individuals. We would be eager to see results of an analysis that takes into account the methodological issues that we have raised.

Authors' response to: Mortality rates for same-sex married individuals compared with opposite-sex married individuals