Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Albert J. Terrillion


Older adults with infectious and chronic diseases, such as cardiovascular disease and human immunodeficiency virus (HIV), are at high risk for associated chronic comorbidities, which are associated with increased medical expenditures to cover treatment costs. The purpose of this study was to investigate (a) whether adults 65 or older with either HIV or cardiovascular disease were predisposed to increased medical expenditures versus adults 64 and younger, and (b) the impact of race and type of health service used on total direct medical expenditures incurred among adults with HIV or cardiovascular disease. A quantitative, deductive, retrospective cross-sectional design was used, and the behavioral model of health services use and the socioecological model were chosen as the study’s theoretical foundations. Analyses were conducted using binary logistic regression. Controlling for confounding variables of education and region of residence, the key findings were that adults ≥ 65 years had higher odds of incurring higher expenditures overall. White patients had higher odds of incurring higher expenditures for medication (OR 1.251), office-based visits (OR 1.433), inpatient visits (OR 1.245), and outpatient visits (OR 1.451) when compared to other races. Older adults with HIV had higher expenditures for medication and home health (OR 1.850); and older adults with cardiovascular disease had higher outpatient (OR 1.235), inpatient (OR 2.142), and emergency room expenditures (OR 1.063). These findings might promote social change because assessing the influences of cost disparities on infectious and chronic diseases can help address variations in health care costs and can initiate the development of tailored evidence-based practice guidelines that can help older adults.