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Cited by 577Meta-analysis and systematic reviewsStatistical Methods in EpidemiologyDelphi Technique in Research

Meta‐analysis of prevalence: I 2 statistic and how to deal with heterogeneity

Migliavaca, Celina Borges, Stein, Cinara, Colpani, Verônica, Barker, Timothy Hugh, Ziegelmann, Patricia Klarmann, Munn, Zachary, Falavigna, Maicon, Prevalence Estimates Reviews—Systematic Review Methodology Group (PERSyst)·2022·Research Synthesis Methods
DOI 10.1002/jrsm.1547
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Abstract

Over the last decade, there has been a 10-fold increase in the number of published systematic reviews of prevalence. In meta-analyses of prevalence, the summary estimate represents an average prevalence from included studies. This estimate is truly informative only if there is no substantial heterogeneity among the different contexts being pooled. In systematic reviews, heterogeneity is usually explored with I-squared statistic (I 2 ), but this statistic does not directly inform us about the distribution of effects and frequently systematic reviewers and readers misinterpret this result. In a sample of 134 meta-analyses of prevalence, the median I 2 was 96.9% (IQR 90.5-98.7). We observed larger I 2 in meta-analysis with higher number of studies and extreme pooled estimates (defined as 90%). Studies with high I 2 values were more likely to have conducted a sensitivity analysis, including subgroup analysis but only three (2%) systematic reviews reported prediction intervals. We observed that meta-analyses of prevalence often present high I 2 values. However, the number of studies included in the meta-analysis and the point estimate can be associated with the I 2 value, and a high I 2 value is not always synonymous with high heterogeneity. In meta-analyses of prevalence, I 2 statistics may not be discriminative and should be interpreted with caution, avoiding arbitrary thresholds. To discuss heterogeneity, reviewers should focus on the description of the expected range of estima…

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  • According to Borges Migliavaca et al. (2022), high heterogeneity is common and expected in prevalence meta-analyses because the outcome varies with time, population assessed, and so on.

    “However, according to Borges Migliavaca et al. (2022) this is common and even expected in prevalence meta-analyses since this outcome varies with time, population assessed, and so on.”

    From Autism in the context of joint hypermobility, hypermobility spectrum disorders, and Ehlers–Danlos syndromes: A systematic review and prevalence meta-analyses (2025) · cites this paper as Borges Migliavaca et al. (2022)

  • Prior work has shown that studies of prevalence have a median I2 of 96.9%, although this does not always correspond to high heterogeneity and I2 should therefore be interpreted with care.

    “Prior work has shown that studies of prevalence have a median I2 of 96.9%, although this does not always correspond to high heterogeneity and I2 should therefore be interpreted with care.125”

    From Adherence to PCSK9 Inhibitors in Clinical Practice (2026) · cites this paper as [125]

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Authors
Migliavaca, C. B., Stein, C., Colpani, V., Barker, T. H., Ziegelmann, P. K., Munn, Z., Falavigna, M., & Prevalence Estimates Reviews—Systematic Review Methodology Group (PERSyst)
Affiliations
  • Hospital de Clínicas de Porto Alegre (BR)
  • Hospital Moinhos de Vento (BR)
  • The University of Adelaide (AU)
  • National Institute of Science and Technology for Health Technology Assessment (INCT/IATS), Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA) Porto Alegre Brazil
Corresponding author
Migliavaca, Celina Borges
ORCID
Venue
Research Synthesis Methods
Publisher
Wiley
Published
2022-02-23
Volume
13
Issue
3
Pages
363-367
ISSN
  • 1759-2879 (ISSN-L)
  • 1759-2887
DOI
10.1002/jrsm.1547
OpenAlex
W4210542220
Cited by
577
References
9
Citations by year
2026: 182 · 2025: 165 · 2024: 133 · 2023: 71 · 2022: 26
FWCI
59.46
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Research Synthesis Methods (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
  • Social Sciences › Sociology and Political Science › Delphi Technique in Research
Keywords
prevalence, heterogeneity, prediction intervals, sensitivity analysis, subgroup analysis
MeSH terms
Systematic Reviews as Topic, Meta-Analysis as Topic, Prevalence

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