Socioeconomic and economic factors affecting access and progression in medical schools: a systematic review and meta-analysis

PURPOSE: Socioeconomic disadvantage remains a major determinant of equitable access to, and progression within, medical education. This systematic review and meta-analysis examines both the impact and the magnitude of financial and economic disadvantage on student selection and progression in medical school. METHODS: Studies were included if they reported associations between socioeconomic indicators (e.g., parental income, occupation, education, geographic deprivation, or premedical debt) and selection or progression outcomes, and were excluded if they lacked clearly defined economic predictors or sufficient data for binary effect sizes. Searches were conducted across PubMed, Scopus, ERIC, Embase, ProQuest, and EBSCO (2005-2025). Study selection employed an active machine-learning screening process. Extracted data included sample characteristics, socioeconomic measures, and outcome types, with risk of bias assessed using the Risk of Bias Instrument. Random-effects meta-analysis was conducted where appropriate. RESULTS: Thirty-two studies of medical programs were included, yielding 28 effect sizes for selection and 9 for progression. Household economic and educational disadvantage, identified through parental indices, was consistently associated with reduced odds of admission (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.55-0.65) and poorer progression (OR, 0.56; 95% CI, 0.53-0.59). Geographic deprivation also exerted a negative effect, particularly on selection (OR, 0.69; 95% CI, 0.5-0.93). CONCLUSION: Socioeconomic disadvantage exerts a pervasive influence across the medical education continuum. Addressing these inequities requires sustained financial, academic, and psychosocial support both before and during their studies. Students' economic circumstances should therefore be considered in medical school selection policy and curriculum development to further enhance equity within medical schools and the profession.