Socioeconomic inequalities in exposure to neighbourhood environments for physical activity: a systematic review

Insufficient physical activity (PA) is a major behavioural determinant of obesity and other noncommunicable diseases. Although the health benefits of PA are well established, many populations, particularly socioeconomically disadvantaged groups, remain insufficiently active. Neighbourhood characteristics play an important role in shaping population physical activity (PA) levels, for example through walkable streets, bikeable infrastructures, playgrounds, green- and blue spaces, and sport facilities. However, PA-supportive environments may be unequally distributed across SEP groups. This systematic review provides a comprehensive synthesis of evidence on socioeconomic inequalities in neighbourhood environments that promote PA across different life stages in high-income countries.

In February 2024, we systematically searched Medline, Embase, Web of Science Core Collection, and Scopus. Eligible studies were quantitative primary research examining objective measures of neighbourhood PA-promoting environments alongside at least one individual- or area-level socioeconomic indicator. Titles and abstracts were screened with ASReview, and full texts were screened manually in duplicate. Data were extracted with a predefined form, and risk of bias was assessed with an adapted version of the AXIS tool. We synthesised our findings narratively and by reported proportions of associations indicating disadvantaged exposure, advantaged exposure, or no statistically significant difference for people with lower SEP.

A total of 250 studies were included. Overall, people with lower SEP were more likely to live in areas with (components of) walkable and bikeable infrastructure, and to have playgrounds nearby, but less likely to have access to formal sports facilities. For other PA-promoting environments, findings were largely null. Patterns varied across age groups, study regions, statistical approaches, and SEP indicators.

Populations with lower SEP were more exposed to walkability components, bikeability, and playgrounds, but less exposed to sports facilities. For most other environments, no clear differences were found. Socioeconomic inequalities in exposure to PA environments are nuanced rather than uniform. This complexity highlights the need to consider multiple environmental features together and to tailor equity-focused interventions to local contexts.