About the Author
My name is Dr. Usha Sethuraman, and I am a pediatric emergency medicine physician at a children’s hospital that is focused on specialized care. I am also a second-year student at the University of Michigan’s School of Public Health in their Population and Health Sciences program. I will be graduating with a focus in epidemiology. Through my work on the California Teachers Study (CTS), I have realized my passion for working with health data, and I am looking forward to a career in epidemiology and data analytics after completing my MPH.
My Research Project
For my Applied Experience (APEx) project, I worked with the CTS to examine whether there was a relationship between self-reported wellbeing and chronic disease. My project focused on participants with cancer, chronic obstructive pulmonary disease (COPD), and cardiovascular disease (CVD).
To answer this question, I looked at self-reported wellbeing outcomes that were collected using the Patient-Reported Outcomes Measurement Information System (PROMIS). PROMIS is a set of person-centered tools developed by the National Institute of Health (NIH). These measures evaluate a patient's physical, mental, and social health. My goal was to describe the distribution of PROMIS responses among study participants with cancer, CVD and COPD, and to compare their responses to participants without those health conditions.
My project used scored PROMIS measures. This scoring process compares the patient’s (or in this case, participant’s) answers to a measure to the answer distribution from a general population. This process generates a single score for each measure. That “T” score places the participant along a continuum to indicate whether their score was normal, mild, moderate, or severe.
I evaluated participant T scores for the following PROMIS measures:
Ability to Participate in Social Activities (APS)
Cognitive Function (CFA)
Emotional Distress and Anxiety (EDA)
Emotional Distress and Depression (EDD)
Fatigue
Pain Interference (PI)
Using these T scores for each PROMIS measure, I completed a statistical analysis to see if there were differences in how participants scored based on their health status.
What I Found
My analysis revealed that compared to those individuals without the diseases of interest, participants with cancer, COPD, and CVD were generally older. This age difference reflects the well-established relationship between aging and the development of chronic diseases; people are more likely to develop diseases as they age.
Also of note was that participants with cancer and CVD reported more difficulty in their ability to participate in social activities compared to participants without these diseases. I also found that a sizable percentage of participants with CVD had higher fatigue and pain interference scores. These findings suggest that these illnesses may cause physical and psychological burdens.
A key finding from my study is that COPD was associated with more severe scores across most all of PROMIS measures except for anxiety. This may be in part due to the chronic respiratory symptoms and other conditions (like osteoarthritis and depression) that often accompany COPD which can have a severe impact on various aspects of life.
Future Goals
These findings emphasize the need for interventions that are aimed at improving the quality of life of patients with chronic conditions. Participants with all three chronic conditions in our study reported some impairment in social participation as well as fatigue. These results underscore patients’ needs for both physical and psychological support as they navigate living with these chronic diseases. Multidisciplinary approaches, including physical therapy, psychological counseling, and social support, may help alleviate some of the negative effects these conditions have on social and emotional well-being.