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The Gerontologist 43:649-660 (2003)
© 2003 The Gerontological Society of America

Patterns and Impact of Comorbidity and Multimorbidity Among Community-Resident American Indian Elders

Robert John, PhD1,, Dave S. Kerby, PhD1 and Catherine Hagan Hennessy, PhD2

Correspondence: Address correspondence to Robert John, PhD, University of Oklahoma Health Sciences Center, Department of Health Promotion Sciences, College of Public Health, PO Box 26901, Oklahoma City, OK 73190. E-mail: Robert-john{at}

Purpose: The purpose of this study is to suggest a new approach to identifying patterns of comorbidity and multimorbidity. Design and Methods: A random sample of 1,039 rural community-resident American Indian elders aged 60 years and older was surveyed. Comorbidity was investigated with four standard approaches, and with cluster analysis. Results: Most respondents (57%) reported 3 or more of 11 chronic conditions. Cluster analysis revealed a four-cluster comorbidity structure: cardiopulmonary, sensory-motor, depression, and arthritis. When the impact of comorbidity on four health-related quality of life outcomes was tested, the use of the clusters offered more explanatory power than the other approaches. Implications: Our study improves understanding of comorbidity within an understudied and underserved population by characterizing comorbidity in conventional and novel ways. The cluster approach has four advantages over previous approaches. In particular, cluster analysis identifies specific health problems that have to be addressed to alter American Indian elders' health-related quality of life.

Key Words: Chronic illness • Health-related quality of life • Functional impairment

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All GSA journals Journals of Gerontology Series A: Biological Sciences and Medical Sciences Journals of Gerontology Series B: Psychological Sciences and Social Sciences
Copyright © 2003 by The Gerontological Society of America.