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These include cardiovascular disease, psychiatric and neurologic disturbances, restless leg syndrome, migraine, cancer, autoimmune diseases, and metabolic disorders. Comorbid disease is an important consideration for clinicians treating patients with MS; early presentation of comorbidities can obscure or delay MS diagnosis, as well as significantly impacting the disease course. Improved understanding of comorbidities and their emergence in MS populations is important for improving the quality of life and optimizing treatment for patients. Therefore, we evaluated published studies reporting epidemiologic data on comorbidities and their associated impact on disease progression in patients with MS (PwMS). The prevalence of neurologic, cardiovascular, metabolic, and autoimmune comorbidities was elevated in PwMS in general, and furthermore, this adversely affected a broad range of outcomes. Compared with PwMS, cancer rates in people without MS or the general population were lower, which should prompt further studies into the mechanisms of both diseases. Studies were under-represented in many regions owing to the latitudinal gradient of MS and possible underfunding of studies.<\/jats:p>","DOI":"10.1007\/s00415-020-10107-y","type":"journal-article","created":{"date-parts":[[2020,7,27]],"date-time":"2020-07-27T14:05:51Z","timestamp":1595858751000},"page":"4066-4077","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":78,"title":["A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications"],"prefix":"10.1007","volume":"268","author":[{"given":"Larissa","family":"Hauer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Perneczky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8749-5533","authenticated-orcid":false,"given":"Johann","family":"Sellner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,27]]},"reference":[{"issue":"5","key":"10107_CR1","doi-asserted-by":"publisher","first-page":"102512","DOI":"10.1016\/j.autrev.2020.102512","volume":"19","author":"H Inojosa","year":"2020","unstructured":"Inojosa H, Schriefer D, Ziemssen T (2020) Clinical outcome measures in multiple sclerosis: a review. 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JS has received speaker honoraria from Biogen, GL-Pharma, Merck, Roche, Sanofi and Teva; serves on advisory boards for Alexion, Biogen, Celgene, Merck, Novartis, Roche, Sanofi, Shire and Teva; He received consultancy fees from Immunic and his institution received research support from Biogen, Roche and Merck.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Code availability"}}]}}