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Meta-Analysis
. 2022 Jan;27(1):19-33.
doi: 10.1038/s41380-021-01295-8. Epub 2021 Sep 27.

A systematic review and meta-analysis on the prevalence of stigma in infectious diseases, including COVID-19: a call to action

Kai Yuan #  1 , Xiao-Lin Huang #  1   2 , Wei Yan #  1 , Yu-Xin Zhang  1   3 , Yi-Miao Gong  1   3 , Si-Zhen Su  1 , Yue-Tong Huang  1 , Yi Zhong  1   3 , Yi-Jie Wang  1   3 , Ze Yuan  2 , Shan-Shan Tian  1 , Yong-Bo Zheng  1   3 , Teng-Teng Fan  1 , Ying-Jian Zhang  1 , Shi-Qiu Meng  4 , Yan-Kun Sun  1 , Xiao Lin  1 , Tian-Ming Zhang  5 , Mao-Sheng Ran  6 , Samuel-Yeung-Shan Wong  7 , Nicolas Rüsch  8 , Le Shi  9 , Yan-Ping Bao  10   11 , Lin Lu  12   13   14
Affiliations
Meta-Analysis

A systematic review and meta-analysis on the prevalence of stigma in infectious diseases, including COVID-19: a call to action

Kai Yuan et al. Mol Psychiatry. 2022 Jan.

Abstract

Infectious diseases, including COVID-19, are crucial public health issues and may lead to considerable fear among the general public and stigmatization of, and discrimination against, specific populations. This meta-analysis aimed to estimate the pooled prevalence of stigma in infectious disease epidemics. We systematically searched PubMed, PsycINFO, Embase, MEDLINE, Web of Science, and Cochrane databases since inception to June 08, 2021, and reported the prevalence of stigma towards people with infectious diseases including SARS, H1N1, MERS, Zika, Ebola, and COVID-19. A total of 50 eligible articles were included that contributed 51 estimates of prevalence in 92722 participants. The overall pooled prevalence of stigma across all populations was 34% [95% CI: 28-40%], including enacted stigma (36% [95% CI: 28-44%]) and perceived stigma (31% [95% CI: 22-40%]). The prevalence of stigma in patients, community population, and health care workers, was 38% [95% CI: 12- 65%], 36% [95% CI: 28-45%], and 30% [95% CI: 20-40%], respectively. The prevalence of stigma in participants from low- and middle-income countries was 37% [95% CI: 29-45%], which is higher than that from high-income countries (27% [95% CI: 18-36%]) though this difference was not statistically significant. A similar trend of prevalence of stigma was also observed in individuals with lower education (47% [95% CI: 23-71%]) compared to higher education level (33% [95% CI: 23-4%]). These findings indicate that stigma is a significant public health concern, and effective and comprehensive interventions are needed to counteract the damaging effects of the infodemics during infectious disease epidemics, including COVID-19, and reduce infectious disease-related stigma.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Study selection flow diagram.
We systematically searched the PubMed, PsycINFO, Embase, MEDLINE, Web of Science, and Cochrane databases to identify studies that reported the prevalence of stigma during infectious disease epidemics. A total of 112,556 articles were identified. After screening, 50 eligible studies were included in this meta-analysis.
Fig. 2
Fig. 2. Prevalence estimates by the study population.
The estimated prevalence of stigma in patients, community population, and health care workers was 38%, 36%, and 30%, respectively. ES effect size (proportion), CI confidence interval.
Fig. 3
Fig. 3. Subgroup analysis of prevalence estimates across variables.
We performed subgroup analyses with regard to stigma type, countries, type of infectious outbreak, gender, education level, and measurement tools. Meta-regression showed that the estimated prevalence based on different characteristics subgroup had no significant difference (p > 0.05).
Fig. 4
Fig. 4. Begg’s funnel plot and Egger test.
There was no publication bias suggested by Begg’s funnel plot (left) and Egger test (right). t = 0.86, p = 0.391.
See this image and copyright information in PMC

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