Objectives: This study aims to explore the socioeconomic determinants influencing dengue virus (DENV) transmission in urban and rural areas, highlighting how these factors contribute to the spread of the disease. Materials and Methods: We conducted a comparative epidemiological study involving 500 households—250 in urban settings and 250 in rural areas—located in high-risk zones. Data collection included household surveys, health records, and interviews to gather comprehensive information on the living conditions and health seeking behaviors of participants. Results: Our findings indicate that urban areas experienced a significantly higher incidence of dengue, with 200 reported cases compared to 95 in rural regions. Urban households exhibited greater overcrowding (70%) and inadequate sanitation (80%), leading to a higher prevalence of mosquito breeding sites (60% in urban vs. 45% in rural areas). Conversely, rural residents faced challenges such as delayed healthcare access, with only 45% seeking treatment within 24 hours compared to 75% in urban settings. Additionally, 70% of rural participants had only primary education or less, which was linked to more severe disease outcomes. Notably, households with low socioeconomic status (SES) were found to be at a higher risk of dengue in both environments, with odds ratios (OR) of 2.5 in urban areas and 1.8 in rural areas. Conclusion:This study underscores the urgent need for tailored public health strategies that address the distinct socioeconomic and environmental challenges faced by urban and rural communities. Focusing on these unique factors can better mitigate dengue transmission and improve health outcomes in affected regions.