
Figure 1
PRISMA flow diagram.
Table 1
Summary characteristics of included studies.
| AUTHOR NAME, YEAR | COUNTRY | STUDY DESIGN | SOURCE OF DATA | SAMPLE SIZE | GENDER | AGE |
|---|---|---|---|---|---|---|
| (MALE %) | (MEAN ± SD) | |||||
| Al akhras et al., 2016 | Egypt | Cross-sectional | Clinical data | 100 | 54 | 14.2 ± 1.37 |
| Aldemir-Kocabas et al., 2014 | Turkey | Case-control | medical record | 41 | 36.5 | 12.4 ± 5.4 |
| Aleem et al., 2000 | Saudi-Arabia | retrospective | case records | 10 | NR | 13.6 |
| Altıncık et al., 2016 | Turkey | Cross-sectional | medical record | 45 | 48.8 | 12.39 ± 3.72 |
| Aydinok et al., 2002 | Turkey | Cross-sectional | medical record | 37 | 56.7 | 14.8 ± 4.9 |
| Beshlawy et al., 2010 | Egypt | Cross-sectional | Clinical data and medical record | 30 | 60 | 13.8 ± 1.7 |
| Canatan et al., 2013 | Turkey | Cross-sectional | questionnaire | 246 | 54.8 | 15.3 ± 8.6 |
| Chhabra et al., 2016 | India | Case control | questionnaire | 114 | 63 | 8-16 y |
| Low et al., 1998 | China | Cross sectional | Clinical data | 71 | 46.4 | 2.1-25 |
| Dama et al., 2015 | India | Cross-sectional | Medical records | 125 | 58.4 | 6 Months-18 |
| Dayasiri et al., 2018 | Sri Lanka | Case control | questionnaire | 40 | NR | 17 |
| Dayer et al., 2012 | Iran | Case control | Clinical data | 30 | NR | 14.1 |
| De Sanctis et al., 2017 | Multinational | Cross-sectional | questionnaire | 3023 | NR | NR |
| De Sanctis et al., 2018 | Multinational | Cross-sectional | questionnaire | 3156 | NR | NR |
| Dhouib et al., 2018 | Tunisia | Cross-sectional | Clinical data | 28 | 57.1 | 19 ± 4.54 |
| Domrongkit et al., 2003 | Thailand | Cross-sectional | Clinical data | 18 | 44.4 | 29.2 ± 2.5 |
| Doulgeraki et al., 2012 | Greece | Cross-sectional | Clinical data | 38 | 52.6 | 5-18 |
| Eshraghi et al., 2011 | Iran | Cross-sectional | questionnaire | 130 | 43.1 | 20.95 ± 7.8 |
| Fahim et al., 2013 | Egypt | Case control | Clinical data | 100 | NR | 7.35 ± 4.7 |
| Fica et al., 2005 | Romania | Cross-sectional | Clinical data and Medical records | 64 | 53.1 | 19.45 ± 6.82 |
| Garcia et al., 1993 | Spain | Cross-sectional | Clinical data | 10 | 40 | 18.9 ± 9.8 |
| Grundy et al., 1994 | England | Cross-sectional | Clinical data | 18 | 61.1 | 12.8 |
| Gulati et al., 2000 | India | Case-control | Clinical data | 84 | 67.8 | 6.6 ± 4.9 |
| Gurlek et al., 2017 | Turkey | Cross-sectional | Clinical data | 24 | 37.5 | 7.1 |
| Habeb et al., 2013 | Saudi Arabia | Cross-sectional | Clinical data | 81 | 51.8 | 12.2 ± 6.85 |
| Hamidah et al., 2001 | Malaysia | Case control | Clinical data | 66 | 54.5 | 2 -24 |
| Hamidieh et al., 2018 | Iran | Cross sectional | Clinical data | 20 | 30 | 10.8 ± 3.9 |
| Hattab et al., 2013 | Qatar | Cross sectional | Clinical data | 54 | 57.4 | 11.6 ± 3.2 |
| Ibrahim et al., 2017 | Pakistan | Cross sectional | Clinical data | 72 | 48.6 | 10-20 |
| Isik et al., 2014 | Turkey | Cross sectional | Clinical data | 47 | 55.3 | 10.0 ± 4.5 |
| Jain et al., 1995 | India | Case control | Clinical data | 25 | 72 | 10.3 ± 3.6 |
| Kanbour et al., 2018 | Qatar | Cross sectional | Clinical data | 24 | 62.5 | 21.75 ± 8.05 |
| Karamifar et al., 2002 | Iran | Cross sectional | Clinical data | 150 | 56 | 14.4 ± 2.8 |
| Karamifar et al., 2005 | Iran | Cross-sectional | Clinical data | 146 | 57.3 | 10-22 |
| Karamifar et al., 2010 | Iran | Case control | Clinical data | 50 | 48 | 14.2 ± 4.8 |
| Karydis et al., 2004 | Greece | Cross sectional | Clinical data | 15 | 73.3 | NR |
| Kattamis et al., 1970 | Greece | Cross sectional | Clinical data | 74 | 52.7 | Less than 11 |
| Kwan et al., 1995 | China | Cross sectional | Clinical data | 68 | 48.5 | 11.3 ± 3.8 |
| Lau et al., 1998 | China | Cross sectional | Clinical data | 12 | 58.3 | 11.4 |
| Li et al., 2004 | China | Cross sectional | Clinical data | 32 | 53.1 | 9.2 ± 4.5 |
| Low et al., 1995 | China | Cross sectional | Clinical data | 15 | NR | NR |
| Low et al., 1997 | China | Cross sectional | Clinical data | 41 | NR | NR |
| Madeddu et al., 1978 | Italy | Case control | Clinical data | 50 | 46 | 2–13 |
| Mahachoklertwattana et al., 2011 | Thailand | Cross sectional | Clinical data | 20 | NR | 11.7 |
| Masala et al., 2003 | Italy | Cross sectional | Clinical data and medical records | 283 | 46.9 | 5-12 |
| Mettananda et al., 2019 | Sri Lanka | Case control | Clinical data | 224 | 49.1 | 10.9 ± 3.6 |
| Mirhosseini et al., 2012 | Iran | Cross sectional | Clinical data | 140 | 56.4 | 8–18 |
| Mirhosseini et al., 2013 | Iran | Cross sectional | Clinical data | 140 | 56.4 | 8–18 |
| Moayeri et al., 2006 | Iran | Cross sectional | Clinical data | 158 | 48.1 | 15.1 ± 4.8 |
| Mohseni et al., 2014 | Iran | Cross sectional | Clinical data | 30 | 46.6 | 5–19 |
| Mousa et al., 2016 | Egypt | Cross sectional | Clinical data | 38 | 57.8 | 23 |
| Nabavizadeh et al., 2007 | Iran | Cross sectional | Clinical data | 121 | 50.4 | NR |
| Najafpour et al., 2008 | Iran | Cross sectional | Medical records | 56 | 64.2 | 15.62 ± 4.44 |
| Ozkan et al., 2001 | Turkey | Cross sectional | Clinical data | 20 | 40 | 1–14 |
| Perera et al., 2010 | Australia | retrospective cohort | Clinical data | 29 | 34.4 | 29 |
| Poggi et al., 2010 | Italy | Cross sectional | Clinical data | 28 | 53.5 | 30 ± 6.2 |
| Roth et al., 1997 | Germany | Cross sectional | Clinical data | 32 | 59.3 | 3 ± 36 |
| Safarinejad et al., 2008 | Iran | Case control | Clinical data | 168 | 100 | 24 ± 4.6 |
| Safarinejad et al., 2010 | Iran | Case control | Clinical data | 106 | 0 | 16.4 ± 2.2 |
| Saffari et al., 2012 | Iran | Cross-sectional | Clinical data | 77 | 51.9 | 21.26 ± 4.53 |
| Saka et al., 1995 | Turkey | Cross sectional | Clinical data | 54 | 46.2 | 10.4 |
| Shah et al., 2019 | Pakistan | Cross sectional | Clinical data | 100 | 53 | 13.62 ± 3.78 |
| Shalitin et al., 2005 | Israel | Cross sectional | Medical records | 39 | 53.8 | 16.3 |
| Shamshirsaz et al., 2003 | Iran | cross-sectional | questionnaires | 220 | 51.5 | 15.2 ± 3.1 |
| Sharma et al., 2016 | India | Prospective | Clinical data | 89 | 57.3 | 13.6 |
| Soliman et al., 2009 | Qatar | Cohort | Clinical data | 272 | NR | 13–21 |
| Soliman et al., 2011 | Qatar | Cross sectional | NR | 26 | NR | 9.5 ± 4.2 |
| Vidergor et al., 2007 | Israel | Case control | Medical records | 16 | 43.7 | NR |
| Vichinsky et al., 2005 | USA | Cross sectional | Medical records | 30 | 46.6 | 8.7 |
| Vogiatzi et al., 2009 | North America | Cross sectional | Clinical data Medical records | 236 | NR | 6.1–75.4 |
| Wu et al., 2003 | Taiwan | cross sectional | Clinical data | 29 | 55.1 | 11.2 ± 4.3 |
| Yaman et al., 2013 | Turkey | Retrospective | Clinical data | 56 | 57.1 | 2–20 |
| Yassin et al., 2018 | Qatar | Cross sectional | Clinical data | 52 | NR | NR |
| Yin et al., 2011 | China | Cross sectional | Medical records | 231 | NR | 5 |
Table 2
The pooled prevalence of endocrine complications in β-thalassemia transfusion-dependent patient.
| COMPLICATION | STUDIES (N) | SAMPLE SIZE (N) | PREVALENCE (%) | 95% CI | P-VALUE | I2 (%) | ||
|---|---|---|---|---|---|---|---|---|
| ST | Gender | Female | 7 | 316 | 50.9 | 41.8–59.9 | 0.850 | 71.33 |
| Male | 7 | 415 | 61.9 | 53.4–69.7 | 0.006 | 39.39 | ||
| Region | Africa | 2 | 138 | 68.1 | 47.8–83.2 | 0.079 | 00.00 | |
| Asia | 35 | 3128 | 49.2 | 44–54.4 | 0.773 | 85.74 | ||
| Europe | 9 | 566 | 36.3 | 27.3–46.4 | 0.008 | 74.46 | ||
| Overall | 46 | 3832 | 48.9 | 35.3–62.6 | 0.873 | 86.69 | ||
| GR | Gender | Female | 6 | 414 | 33.1 | 9.4–70.2 | 0.377 | 96.02 |
| Male | 6 | 292 | 51.6 | 17.8–84 | 0.938 | 94.81 | ||
| Region | Africa | 1 | 28 | 57 | 9.1–94.6 | 0.831 | 00.00 | |
| America | 1 | 30 | 27 | 2.7–83.3 | 0.454 | 00.00 | ||
| Asia | 12 | 1015 | 42.1 | 25.5–60.7 | 0.410 | 95.02 | ||
| Europe | 3 | 3316 | 39.3 | 12.7–74.2 | 0.566 | 98.37 | ||
| Oceania | 1 | 29 | 35 | 3.9–87.8 | 0.639 | 00.00 | ||
| Overall | 18 | 4418 | 41.1 | 27.5–56.4 | 0.253 | 95.39 | ||
| GH | Region | Africa | 2 | 46 | 34.1 | 8.9–73.2 | 0.438 | 00.00 |
| Asia | 8 | 855 | 27 | 14–45.5 | 0.017 | 92.36 | ||
| Europe | 3 | 3200 | 21.6 | 6.8–50.9 | 0.057 | 97.96 | ||
| Overall | 13 | 4101 | 26.6 | 16–40.8 | 0.002 | 98.11 | ||

Figure 2
Forrest plot of the pooled prevalence of ST in B-thalassemia transfusion-dependent patients.

Figure 3
Forrest plot of the pooled prevalence of ST subgrouped by gender in B-thalassemia transfusion-dependent patients.

Figure 4
Forrest plot of the pooled prevalence of GR in B-thalassemia transfusion-dependent patients.

Figure 5
Forrest plot of the pooled prevalence of GR sub-grouped by gender in B-thalassemia transfusion-dependent patients.

Figure 6
Forrest plot of the pooled prevalence of GH in B-thalassemia transfusion-dependent patients.
