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Eligibility for shingles vaccination and hospital-coded dementia in England and Wales: a regression discontinuity analysis in England
Hamilton F, de Moira AP, Bracher-Smith M, Michalik F, Chandran S, Cattaneo MD, De Magalhaes L, Hartwig FP et al.. medRxiv, 2026-07-21
Topic: Health services, long-term care and technology
We used the September 2013 age-based rollout of the live-attenuated shingles vaccine in England as a natural experiment to estimate the effect of vaccine eligibility on shingles and dementia diagnoses in linked hospital records. Individuals born just before and after the eligibility cutoff were compared using regression discontinuity methods, with follow-up for up to eight years after programme introduction. Eligibility was associated with a clear reduction in hospital-coded shingles diagnoses (RD estimate - 0.12 percentage points, 95% CI -0.153 to -0.079; p = 5.9 × 10 -10 ), but there was no evidence of a corresponding reduction in hospital-coded dementia diagnoses (RD estimate -0.06 percentage points, 95% CI -0.40 to 0.27; p = 0.72). Results were robust across denominator definitions, diagnostic-code specifications, estimator choice, placebo cutoffs, and negative-control analyses. The dementia estimate was also close to null in an independently conducted analysis using a separately held HES extract. Comparator analyses in Welsh data with linked primary care and death data did not suggest these results were driven by our reliance on hospital data. These findings do not support a detectable intention-to-treat effect of live-attenuated shingles vaccine eligibility on hospital-coded dementia in England.
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APA 7th
Hamilton, F., de Moira, A. P., Bracher-Smith, M., Michalik, F., Chandran, S., Cattaneo, M. D., et al. (2026). Eligibility for shingles vaccination and hospital-coded dementia in England and Wales: a regression discontinuity analysis in England. medRxiv. https://doi.org/10.64898/2026.07.20.26358345
Vancouver
Hamilton F, de Moira AP, Bracher-Smith M, Michalik F, Chandran S, Cattaneo MD, et al. Eligibility for shingles vaccination and hospital-coded dementia in England and Wales: a regression discontinuity analysis in England. medRxiv. 2026. doi:10.64898/2026.07.20.26358345.
BibTeX
@article{hamilton2026-6ea1729d,
author = {Hamilton, F. and de Moira, A. P. and Bracher-Smith, M. and Michalik, F. and Chandran, S. and Cattaneo, M. D. and De Magalhaes, L. and Hartwig, F. P. and others},
title = {{Eligibility for shingles vaccination and hospital-coded dementia in England and Wales: a regression discontinuity analysis in England}},
journal = {medRxiv},
year = {2026},
doi = {10.64898/2026.07.20.26358345},
url = {https://doi.org/10.64898/2026.07.20.26358345}
}
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Key findings
- Eligibility was associated with a clear reduction in hospital-coded shingles diagnoses (RD estimate - 0.12 percentage points, 95% CI -0.153 to -0.079; p = 5.9 × 10 -10 ), but there was no evidence of a corresponding reduction in hospital-coded dementia diagnoses (RD estimate -0.06 percentage points, 95% CI -0.40 to 0.27; p = 0.72).
- Results were robust across denominator definitions, diagnostic-code specifications, estimator choice, placebo cutoffs, and negative-control analyses.
- Comparator analyses in Welsh data with linked primary care and death data did not suggest these results were driven by our reliance on hospital data.
- These findings do not support a detectable intention-to-treat effect of live-attenuated shingles vaccine eligibility on hospital-coded dementia in England.
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Study details
- Evidence strengthLow
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 24 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 15 of the 62 points we could judge it on, which is 24 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Points | 15 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 15 of the 62 points we could judge it on is 24 out of 100. |
| Total | 24 / 100 | Capped to 16 because this is not a peer-reviewed article. |
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