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Behavioral and Socioeconomic Pathways Underlying Rural-Urban Disparities in Adolescent Overweight and Obesity: A Systematic Review and Meta-Analysis

Year: 2026
Type: review
Abstract: Introduction: Adolescent overweight and obesity vary by place of residence, but rural–urban disparities may reflect interacting behavioral and socioeconomic pathways rather than residence itself. Objectives: To quantify the pooled association between rural versus urban residence and overweight and obesity among adolescents and organise potential behavioral and socioeconomic pathways underlying these disparities. Methods: Five databases (PubMed, Embase, Cochrane CENTRAL, Scopus, and Web of Science) were searched, supplemented by citation and hand searching. Observational studies reporting adolescent overweight and obesity separately for rural and urban groups were eligible. Two reviewers independently screened, extracted, and appraised studies, with disagreements resolved by a third reviewer. Risk of bias was assessed using the Newcastle–Ottawa Scale. Odds ratios were pooled using a DerSimonian–Laird random-effects model. Heterogeneity, leave-one-out and influence analyses, and subgroup analysis by country income context were conducted. Results: Seven studies were included; five provided poolable event counts (63,659 adolescents) and two contributed adjusted estimates. The pooled OR for rural versus urban residence was 0.97 (95% CI: 0.61–1.54), with very high heterogeneity (I² = 93.3%) and a prediction interval of 0.18–5.38. In high-income countries, odds were higher among rural adolescents (OR = 1.35, 95% CI: 1.03–1.78), whereas middle-income countries showed an imprecise estimate (OR = 0.63, 95% CI: 0.09–4.61). Removing the influential Nigerian study shifted the pooled OR to 1.44 (95% CI: 1.14–1.82). Conclusions: The overall association was null but heterogeneous and context dependent. Rural–urban disparities appear to reflect interacting behavioral and socioeconomic pathways. The certainty of evidence was very low, and findings are hypothesis generating.
Language: English
Field: Medicine
Open Access status: diamond
OpenAlex ID: W7218044848
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