To evaluate and compare the risks of cardiometabolic comorbidities and all-cause mortality between individuals with preserved ratio impaired spirometry (PRISm) and those with chronic obstructive pulmonary disease (COPD). A systematic literature search was conducted across CNKI, Wanfang Database, VIP Database, SinoMed, PubMed, Embase, Web of Science, and the Cochrane Library from inception to February 2026 to identify observational studies comparing PRISm (FEV 1 /FVC ≥ 0.70 and FEV 1 0.05). Subgroup analyses revealed that diabetes risk was higher in Western populations ( P = 0.002), while all-cause mortality was lower in the PRISm group than in the COPD group specifically among Asian populations ( P < 0.001). PRISm is associated with higher risks of hypertension, diabetes, and obesity compared with COPD, highlighting cardiometabolic dysfunction as an important clinical feature. Although the all-cause mortality risk of PRISm was comparable to that of COPD, ethnic heterogeneity was observed in its clinical characteristics. These findings suggest that PRISm may represents a clinically important and heterogeneous lung function phenotype requiring greater clinical attention.
Deng et al. (2026) studied this question.