Author(s): Jannatul Nayeem
Mentor(s): Jenny Phan, CASSBI
A
Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder often accompanied by chronic pain, yet the biological and social determinants of this pain remain underexplored. Understanding how stress-related biomarkers and healthcare access interact in shaping pain experiences may reveal mechanisms underlying health disparities in PCOS populations.
Objective:
This study examined associations between inflammatory and neuroendocrine biomarkers (C-reactive protein (CRP), cortisol, and body mass index (BMI)) and pain burden among individuals with PCOS, while exploring the moderating role of healthcare access and insurance coverage.
Methods:
Using data from the All of Us Research Program, 2,160 adults with PCOS (identified by ICD-9/10 codes) were analyzed. Pain burden was measured through pain-related diagnoses and pain medication dosage. Biomarker distributions were winsorized, log-transformed, and analyzed via multivariate regression models adjusting for age, race, socioeconomic status, and healthcare variables.
Results:
Pain burden alone was not significantly associated with higher CRP, cortisol, or BMI levels. However, healthcare access moderated these relationships: participants with greater barriers to care exhibited elevated inflammation and BMI with increasing pain, whereas those with adequate access showed flatter or reduced biomarker trends.
Conclusions:
Findings suggest that chronic pain and stress responses in PCOS may be shaped more by social and contextual factors than biological burden alone. Enhancing healthcare accessibility and equity could mitigate stress-related physiological outcomes and improve pain management for individuals with PCOS.
0:13 Jenny, um, in her our static load study. Which is the body’s biological stress response, and how it relates to menstrual disorders and chronic pain.
0:23 Um, from that study, I wanted to dive deeper into PCOS, and look at pain medication use and biomarker. Or associations and individuals with that disorder.
0:36 Umm, for methodology, I started off by using, umm, the all of us data set, uhh, database. Umm, it has a ton of data on- individuals, uhh, with all sorts of diseases and, umm, information from their doctor visits, umm, patient records, and also, umm, some survey questions that, the program itself asks
1:06 those participants, umm, and so through that, through that database, I was able to find what 2160 individuals with PCOS, and dive deeper into, uhh, their- biomarkers, uh, specifically for this, I’m using, umm, 3 biomarkers as predictors for inflammation and stress.
1:30 I’m using BMI, C-reactive protein, and cortisol. And then, umm, for- for their outcome variable, I use pain diagnosis along with their medication usage, umm, for medication usage, umm, I accounted for, umm, how many medications they’re taking.
1:52 And, and also what the dosage was for that medication, umm, and then some co-variates, such moderators that, sorry, some co-variates that I used was age, race, uhh, and SES index, and then for moderators, umm, I looked at healthcare access, uh, specifically insurance insurance status and access to care
2:19 . there. And so, I’m going to zoom into the results that I had, umm, hopefully in the video it resumes in two.
2:33 umm, but for my results, I found that, umm, pain alone didn’t start- we predict inflammation or stress, but limited access to care did.
2:45 Individuals with more barriers, such as lack of insurance, showed higher inflammation and BMI with pain, suggesting that health equity plays a critical role in PCOS pain.
2:56 Um, while my insurance data was limited, uh, because, uh, that not many people answered those questions, um, there’s still show some support that the idea- that stress biology and pain in PCOS are influenced by social environment and not just physiology.
3:22 Um, right now, I am continuing this study, um, to- or they’re deep in my understanding and advocate for equitable pain care in PCOS populations.
3:36 Umm, and so one thing I want to focus on more is, uh, imp- moving, um, how we, uh, state these questions, because I do feel like how the, uh, question is stated about access to care and insurance status is pretty sensitive.
3:58 So how can we go about it to, change the way, um, someone feels about answering those type of questions. Um, and so yeah, that was my study.
4:09 Thank you for listening.