ArticleNeurology2018
Effects of physical comorbidities on disability progression in multiple sclerosis.
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Article in Neurology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers.
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42citing papers in PubMed
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Who cites it
42 citing papers in PubMed.
- Vascular Comorbidities and an Increased Comorbidity Score Are Associated With Disability and Disability Progression in Secondary Progressive Multiple Sclerosis.European journal of neurology · 2026Trial
- Comorbidity is associated with disease activity in MS: Findings from the CombiRx trial.Neurology · 2020Trial
- Real-World Effectiveness and Safety of Ofatumumab: Analysis of B Cell Depletion, Comorbidities and Ethnicity in a Spanish Cohort.Neurology and therapy · 2026Article
- Smoking, Comorbidities, and Low Sun Exposure Are Associated with Clinical and Radiological Outcomes in Patients with Multiple Sclerosis-A Four-Year Observational Cohort Study.Journal of clinical medicine · 2026Article
- Cardiovascular comorbidities are associated with cross-sectional and longitudinal measures of multiple sclerosis fatigue.Multiple sclerosis (Houndmills, Basingstoke, England) · 2026Article
- Comorbidities at MS Diagnosis and Their Association With Treatment Persistence: Real-World Clinical Data.Brain and behavior · 2026Article
- [XVII Post-ECTRIMS Meeting: Review of the New Developments Presented at the 2024 ECTRIMS Congress (I)].Revista de neurologia · 2026Review
- Comorbidity and modifiable risk factors in multiple sclerosis.Therapeutic advances in neurological disorders · 2026Review
- Multiple sclerosis pathophysiology: a comprehensive review of genetic, environmental, and immunological drivers.Inflammopharmacology · 2025Review
- A narrative review on the safety of glatiramer acetate in multiple sclerosis: focus on Europe.Therapeutic advances in chronic disease · 2025Review
- Assessing disease progression and treatment response in progressive multiple sclerosis.Nature reviews. Neurology · 2024Review
- Comorbidity and Disease Activity in Multiple Sclerosis.JAMA neurology · 2024Article
- Using the Progression Independent of Relapse Activity Framework to Unveil the Pathobiological Foundations of Multiple Sclerosis.Neurology · 2024Review
- The Prevalence of Comorbidities and Their Association With Disability Progression in Individuals With Multiple Sclerosis: A Study From Brazil.International journal of MS care · 2024Article
- Clinical Characteristics and Long-Term Outcomes of Late-Onset Multiple Sclerosis: A Swedish Nationwide Study.Neurology · 2024Article
- Perceived health- related quality of life in persons with multiple sclerosis with and without a vascular comorbidity.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2024Article
- The Canadian Prospective Cohort Study to understand progression in multiple sclerosis: baseline characteristics.Therapeutic advances in neurological disorders · 2024Article
- Exploring the Role of Plasma Lipids and Statin Interventions on Multiple Sclerosis Risk and Severity: A Mendelian Randomization Study.Neurology · 2023Article
- The Barancik lecture: Comorbidity in multiple sclerosis-Looking backward, looking forward.Multiple sclerosis (Houndmills, Basingstoke, England) · 2023Article
- Etiology, effects and management of comorbidities in multiple sclerosis: recent advances.Frontiers in immunology · 2023Review
Corrections and comments
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Authors and funding
13 authors.
Tingting ZhangFrom the Department of Health Services, Policy and Practice (T.Z.), Brown University School of Public Health, Providence, RI; Department of Medicine (H.T., F.Z., E.K., R.C.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., V.B., T.C.), Department of Psychiatry (J.D.F.), and School of Nursing (T.C.), Dalhousie University; Nova Scotia Health Authority (J.D.F., V.B., K.S.), Halifax; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University; The Research Institute of the McGill University Health Centre (C.W.), Montreal, Quebec; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. tingting_zhang@brown.edu.
Helen TremlettFrom the Department of Health Services, Policy and Practice (T.Z.), Brown University School of Public Health, Providence, RI; Department of Medicine (H.T., F.Z., E.K., R.C.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., V.B., T.C.), Department of Psychiatry (J.D.F.), and School of Nursing (T.C.), Dalhousie University; Nova Scotia Health Authority (J.D.F., V.B., K.S.), Halifax; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University; The Research Institute of the McGill University Health Centre (C.W.), Montreal, Quebec; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Feng ZhuFrom the Department of Health Services, Policy and Practice (T.Z.), Brown University School of Public Health, Providence, RI; Department of Medicine (H.T., F.Z., E.K., R.C.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., V.B., T.C.), Department of Psychiatry (J.D.F.), and School of Nursing (T.C.), Dalhousie University; Nova Scotia Health Authority (J.D.F., V.B., K.S.), Halifax; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University; The Research Institute of the McGill University Health Centre (C.W.), Montreal, Quebec; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Elaine KingwellFrom the Department of Health Services, Policy and Practice (T.Z.), Brown University School of Public Health, Providence, RI; Department of Medicine (H.T., F.Z., E.K., R.C.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., V.B., T.C.), Department of Psychiatry (J.D.F.), and School of Nursing (T.C.), Dalhousie University; Nova Scotia Health Authority (J.D.F., V.B., K.S.), Halifax; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University; The Research Institute of the McGill University Health Centre (C.W.), Montreal, Quebec; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
John D FiskFrom the Department of Health Services, Policy and Practice (T.Z.), Brown University School of Public Health, Providence, RI; Department of Medicine (H.T., F.Z., E.K., R.C.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., V.B., T.C.), Department of Psychiatry (J.D.F.), and School of Nursing (T.C.), Dalhousie University; Nova Scotia Health Authority (J.D.F., V.B., K.S.), Halifax; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University; The Research Institute of the McGill University Health Centre (C.W.), Montreal, Quebec; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Virender BhanFrom the Department of Health Services, Policy and Practice (T.Z.), Brown University School of Public Health, Providence, RI; Department of Medicine (H.T., F.Z., E.K., R.C.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., V.B., T.C.), Department of Psychiatry (J.D.F.), and School of Nursing (T.C.), Dalhousie University; Nova Scotia Health Authority (J.D.F., V.B., K.S.), Halifax; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University; The Research Institute of the McGill University Health Centre (C.W.), Montreal, Quebec; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Trudy CampbellFrom the Department of Health Services, Policy and Practice (T.Z.), Brown University School of Public Health, Providence, RI; Department of Medicine (H.T., F.Z., E.K., R.C.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., V.B., T.C.), Department of Psychiatry (J.D.F.), and School of Nursing (T.C.), Dalhousie University; Nova Scotia Health Authority (J.D.F., V.B., K.S.), Halifax; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University; The Research Institute of the McGill University Health Centre (C.W.), Montreal, Quebec; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Karen StadnykFrom the Department of Health Services, Policy and Practice (T.Z.), Brown University School of Public Health, Providence, RI; Department of Medicine (H.T., F.Z., E.K., R.C.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., V.B., T.C.), Department of Psychiatry (J.D.F.), and School of Nursing (T.C.), Dalhousie University; Nova Scotia Health Authority (J.D.F., V.B., K.S.), Halifax; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University; The Research Institute of the McGill University Health Centre (C.W.), Montreal, Quebec; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Robert CarruthersFrom the Department of Health Services, Policy and Practice (T.Z.), Brown University School of Public Health, Providence, RI; Department of Medicine (H.T., F.Z., E.K., R.C.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., V.B., T.C.), Department of Psychiatry (J.D.F.), and School of Nursing (T.C.), Dalhousie University; Nova Scotia Health Authority (J.D.F., V.B., K.S.), Halifax; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University; The Research Institute of the McGill University Health Centre (C.W.), Montreal, Quebec; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Christina WolfsonFrom the Department of Health Services, Policy and Practice (T.Z.), Brown University School of Public Health, Providence, RI; Department of Medicine (H.T., F.Z., E.K., R.C.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., V.B., T.C.), Department of Psychiatry (J.D.F.), and School of Nursing (T.C.), Dalhousie University; Nova Scotia Health Authority (J.D.F., V.B., K.S.), Halifax; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University; The Research Institute of the McGill University Health Centre (C.W.), Montreal, Quebec; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Sharon WarrenFrom the Department of Health Services, Policy and Practice (T.Z.), Brown University School of Public Health, Providence, RI; Department of Medicine (H.T., F.Z., E.K., R.C.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., V.B., T.C.), Department of Psychiatry (J.D.F.), and School of Nursing (T.C.), Dalhousie University; Nova Scotia Health Authority (J.D.F., V.B., K.S.), Halifax; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University; The Research Institute of the McGill University Health Centre (C.W.), Montreal, Quebec; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Ruth Ann MarrieFrom the Department of Health Services, Policy and Practice (T.Z.), Brown University School of Public Health, Providence, RI; Department of Medicine (H.T., F.Z., E.K., R.C.), Division of Neurology and Centre for Brain Health, University of British Columbia, Vancouver; Department of Medicine (J.D.F., V.B., T.C.), Department of Psychiatry (J.D.F.), and School of Nursing (T.C.), Dalhousie University; Nova Scotia Health Authority (J.D.F., V.B., K.S.), Halifax; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University; The Research Institute of the McGill University Health Centre (C.W.), Montreal, Quebec; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo examine the association between physical comorbidities and disability progression in multiple sclerosis (MS).
methodsWe conducted a retrospective cohort study using linked health administrative and clinical databases in 2 Canadian provinces. Participants included adults with incident MS between 1990 and 2010 who entered the cohort at their MS symptom onset date. Comorbidity status was identified with validated algorithms for health administrative data and was measured during the 1 year before study entry and throughout the study period. The outcome was the Expanded Disability Status Scale (EDSS) score as recorded at each clinic visit. We used generalized estimating equations to examine the association between physical comorbidities and EDSS scores over time, adjusting for sex, age, cohort entry year, use of disease-modifying drugs, disease course, and socioeconomic status. Meta-analyses were used to estimate overall effects across the 2 provinces.
resultsWe identified 3,166 individuals with incident MS. Physical comorbidity was associated with disability; with each additional comorbidity, there was a mean increase in the EDSS score of 0.18 (95% confidence interval [CI] 0.09-0.28). Among specific comorbidities, the presence of ischemic heart disease (IHD) or epilepsy was associated with higher EDSS scores (IHD 0.31, 95% CI 0.01-0.61; epilepsy 0.68, 95% CI 0.11-1.26).
conclusionsPhysical comorbidities are associated with an apparent increase in MS disability progression. Appropriate management of comorbidities needs to be determined to optimize outcomes.
Indexed as
Disease ProgressionAdultCanadaCohort StudiesComorbidityDatabases, FactualDisability EvaluationFemaleHumansHypertensionLinear ModelsLung DiseasesMaleMiddle AgedMultiple Sclerosis
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