Urban-rural disparities in metabolic syndrome prevalence and risk factors among industrial workers in central Thailand: A cross-sectional comparative study

Background: Metabolic syndrome (MetS) prevalence varies substantially between urban and rural settings, reflecting differences in access to healthcare services, food environments, and lifestyle patterns. Industrial workers in Thailand face distinct metabolic health challenges shaped by the geographical location of their workplaces and the associated policy contexts. Objectives: To compare MetS prevalence, anthropometric profiles and metabolic risk factors between industrial workers in urban and rural areas of central Thailand, and to examine the influence of geographical location on MetS risk after adjustment for individual-level factors. Materials and methods: This cross-sectional comparative study used stratified multistage random sampling to enroll 480 industrial workers (240 urban, 240 rural; 93.8% participation among eligible workers) aged 25-59 years from industrial estates in Health Service Region 4, Thailand, during December 2025, following institutional ethical approval granted on 28 November 2025. Data were collected using a validated mobile application and a LINE Official Account for appointment scheduling and information gathering. Anthropometric measurements, each taken in duplicate and averaged, included body mass index, waist circumference, torso-to-head ratio and umbilical waist circumference. Biochemical assessment comprised fasting plasma glucose, lipid profile and duplicate blood pressure measurements. MetS was diagnosed using the harmonized criteria. Logistic regression identified crude and adjusted predictors of MetS, adjusting for sociodemographic, lifestyle and occupational factors, including alcohol use, sleep duration, perceived stress, working hours, medication use, family history of cardiovascular disease, employment duration and occupational class. Results: Overall MetS prevalence was 38.5% (N=185) and was significantly higher in urban workers (46.3%, 111/240) than in rural workers (30.8%, 74/240, p<0.001); both estimates exceeded the 28% national prevalence reported in the 6th Thai National Health Examination Survey. Urban workers had significantly higher mean body mass index (27.2±3.8 vs 25.1±3.2 kg/m², p<0.001), waist circumference (89.4±9.2 vs 84.6±8.5 cm, p<0.001), and prevalence of central obesity (58.3% vs 42.5%, p=0.001). After adjustment for age, sex, education, income, smoking, physical activity, dietary pattern, and additional occupational and psychosocial covariates, urban residence remained independently associated with MetS (adjusted OR 2.18, 95% CI 1.42-3.35, p<0.001, crude OR 1.93, 95% CI 1.33-2.81). Stratified analysis showed that urban workers had a higher prevalence of elevated triglycerides (51.7% vs 38.3%, p=0.004) and reduced HDL-cholesterol (44.2% vs 32.1%, p=0.008). Conclusion: Substantial urban–rural disparities in MetS prevalence exist among industrial workers in central Thailand, with urban residence associated with higher metabolic risk independently of the individual characteristics measured. These findings highlight the need for geographically tailored workplace health interventions addressing area-specific food environments and physical activity infrastructure.