Prevalence and risk profiles of metabolic abnormalities (PRIMA): a large-scale, multicenter cross-sectional study among inpatients with schizophrenia in China

Metabolic abnormalities are prevalent among individuals with schizophrenia, contributing to increased medical burden and premature mortality. However, representative data from mainland China remain scarce, particularly within inpatient populations. This study aims to investigate the prevalence and risk profiles of metabolic abnormalities among inpatients with schizophrenia in mainland China. We conducted a large-scale, multicenter cross-sectional study, consecutively enrolling adult inpatients with schizophrenia from 218 psychiatric and general hospitals across six major regions of China between January and December 2023. Metabolic abnormalities were defined according to standard clinical criteria for waist circumference, blood pressure, serum lipids, and fasting glucose. Chi-square tests and ordinal logistic regression analyses were used to identify high-risk profiles. A total of 18,499 valid cases were analyzed, with 84.51% of patients exhibiting at least one metabolic abnormality. The overall metabolic syndrome prevalence was 28.2%, with marked regional variation (17.2%–48.4%). Patients with metabolic abnormalities were more likely to have a later age at onset, co-occurring depressive symptoms, unhealthy lifestyle behaviors, marital history or unemployment, lower educational attainment, and a family history of cardiometabolic disorders. Among commonly used atypical antipsychotics, olanzapine showed the strongest association with metabolic abnormalities (OR = 1.21, 95% CI: 1.04–1.40), whereas ziprasidone showed the weakest (OR = 0.71, 95% CI: 0.54–0.93). In China, hospitalized patients with schizophrenia exhibit a high prevalence of metabolic abnormalities. Social disadvantage, greater illness burden, and exposure to commonly prescribed atypical antipsychotics characterize high-risk profiles, informing efforts toward early identification and integrated preventive interventions. Not applicable.