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Open Access Research article

Age- and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: a systematic review

Mehlika Toy12*, Fatih Oguz Önder3, Tanja Wörmann4, A Mithat Bozdayi5, Solko W Schalm26, Gerard J Borsboom1, Joost van Rosmalen1, Jan Hendrik Richardus1 and Cihan Yurdaydin57

Author Affiliations

1 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50,3000 CA Rotterdam, the Netherlands

2 LiverDoc, Rotterdam, the Netherlands

3 Department of Gastroenterology, Yuksek Ihtisas Hospital, Kızılay Sk. 06100 Sıhhıye, Ankara, Turkey

4 Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Northrhine-Westphalia, Germany

5 Institute of Hepatology, Ankara University, Cemal Gursel caddesi, Ankara, Turkey

6 Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50,3000 CA Rotterdam, the Netherlands

7 Department of Gastroenterology, School of Medicine, Ankara University, Cemal Gursel caddesi, Ankara, Turkey

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BMC Infectious Diseases 2011, 11:337  doi:10.1186/1471-2334-11-337

Published: 12 December 2011



To provide a clear picture of the current hepatitis B situation, the authors performed a systematic review to estimate the age- and region-specific prevalence of chronic hepatitis B (CHB) in Turkey.


A total of 339 studies with original data on the prevalence of hepatitis B surface antigen (HBsAg) in Turkey and published between 1999 and 2009 were identified through a search of electronic databases, by reviewing citations, and by writing to authors. After a critical assessment, the authors included 129 studies, divided into categories: 'age-specific'; 'region-specific'; and 'specific population group'. To account for the differences among the studies, a generalized linear mixed model was used to estimate the overall prevalence across all age groups and regions. For specific population groups, the authors calculated the weighted mean prevalence.


The estimated overall population prevalence was 4.57, 95% confidence interval (CI): 3.58, 5.76, and the estimated total number of CHB cases was about 3.3 million. The outcomes of the age-specific groups varied from 2.84, (95% CI: 2.60, 3.10) for the 0-14-yearolds to 6.36 (95% CI: 5.83, 6.90) in the 25-34-year-old group.


There are large age-group and regional differences in CHB prevalence in Turkey, where CHB remains a serious health problem.