IntroductionDengue remains a significant global health threat, with the majority of cases concentrated in high-burden countries (HBCs) where climatic factors shape transmission. This systematic review and meta-analysis synthesize evidence on the associations between key climatic variables (temperature, relative humidity, rainfall, and wind speed) and dengue incidence in these settings.MethodsA systematic search of PubMed and Scopus was conducted up to June 27, 2025, following the PRISMA guidelines. Non-general-population studies, and other non-primary sources were excluded. Effect estimates were extracted from 45 eligible studies for meta-analysis, and pooled relative risks (RRs) per unit increase in each climatic variable were calculated using a random-effects meta-analysis, with subgroup analyses to explore heterogeneity. Evidence quality and strength were appraised using the Navigation Guide systematic review framework.ResultsA total of 1,279 records were screened, and 140 studies met the inclusion criteria, of which 45 studies were eligible for meta-analysis, predominantly from tropical countries such as Brazil, India, and Indonesia. More than 80% of eligible studies showed low risk of bias in confounding, exposure and outcome assessment. Pooled estimates indicated a 16% increase in dengue incidence per 1 °C rise in temperature (RR = 1.16; 95% confidence interval [CI]: 1.08–1.25), a 5% increase per unit rise in relative humidity (RR = 1.05; 95% CI: 1.00–1.11), and a positive association for rainfall (RR = 1.00; 95% CI: 0.98–1.03). Wind speed demonstrated a negative association (RR = 0.91; 95% CI: 0.70–1.17) from three available studies. Overall, the strength of evidence was rated as ‘limited’ for temperature, humidity, and rainfall, and ‘inadequate’ for wind speed.DiscussionAlthough significant associations between key climatic factors and dengue were observed, considerable spatio-temporal heterogeneity persists in the evidence. The interdependent nature of the climatic variables complicating the independent effects to individual climatic variables. Therefore, well-designed research using finer-scale climatic and dengue datasets from HBCs is essential to improve understanding of climate-driven dengue dynamics.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251132403, identifier PROSPERO (CRD420251132403).