IMPACT ON HEALTH

Black-white life expectancy gap shrinking

The life expectancy gap between whites and African-Americans in the U.S. has narrowed since 1993, thanks largely to declines in homicide rates, HIV mortality, accidental deaths and heart disease mortality among women, a new report shows.

However, heart disease remains the main reason white men live 6.3 years longer than African-American men, on average, while white women outlive African-American females by 4.5 years, Dr. Sam Harper of McGill University in Montreal, Quebec, and colleagues found. While the study found declines in homicide, HIV infections, and infant deaths, all three "continue to keep the black-white gap unnecessarily large," Harper's group states.

"Yes, there's some good news, but we have a long way to go," Harper told Reuters.

The black-white gap in U.S. life expectancy narrowed throughout the 1970s and early 1980s but widened from 1984 through the early 1990s. It began to narrow again from about 1994 to today, Harper and his team note in the March 21 issue of the Journal of the American Medical Association.

To better understand how causes of death among different age groups were responsible for these trends, Harper and his colleagues analyzed mortality data from 1983 to 2003 in the U.S. National Vital Statistics System.

From 1983 to 1993 the life expectancy gap between blacks and whites increased by 31 percent for males, while it increased by 10 percent for females, the researchers found. But between 1993 and 2003 the gap for both males and females narrowed by 25 percent.

Homicide was the key contributing factor to the life expectancy gap among males for most of the study period, but by 2003 heart disease had become the leading factor, followed by homicide, HIV and infant deaths.

For women, heart disease was the chief contributor to racial life expectancy disparities throughout the study period, while other key factors included diabetes, stroke and infant deaths.

Sharp declines in HIV and homicide deaths accounted for 55 percent of the reduction of the mortality gap between 1993 and 2003, the researchers found, while declines in death from unintentional injuries accounted for 16 percent. At the same time, the researchers found, deaths by unintentional poisoning, which usually represent overdose among narcotics users, showed a proportional increase among middle-aged whites.

And while cardiovascular disease deaths declined for African-American women and for African-American men younger than 60, they rose for men 60 years or older, the researchers found.

"Cardiovascular disease accounts for about 30 percent of the existing gap among men and about 40 percent of the existing gap among women," Harper said. A stronger focus on reducing high blood pressure among African-Americans could go a long way toward helping to reduce this gap, he added.

Other essential efforts will include trying to bring down homicide rates, helping more people get tested for HIV, and improving access to treatment for the disease, Harper said. (Reuters)

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Medicine Enough for Pain in Chest?

Thousands of people with crushing chest pain who once opted for angioplasty as a quick fix may change their minds based on a landmark study out Monday showing that medication costs less, poses fewer risks and works just as well.

"I think this will change the discussion between the patient and doctor," says Raymond Gibbons of the Mayo Clinic and president of the American Heart Association. "In some cases it will lead to a decision not to use angioplasty and a stent."

The study of 2,287 heart patients with chronic but stable chest pain is the first to show that taking medication alone is as effective as coupling medicines with angioplasty, in which a tiny balloon is threaded into arteries supplying the heart, for preventing deaths, heart attacks and hospitalization.

After five years, the researchers found no significant differences between the two groups in deaths, heart attacks or strokes.

Doctors say the findings in no way challenge the benefit of using emergency angioplasty to stop heart attacks before they damage the heart.

Researcher William Boden of Western New York VA health care Network in Buffalo called the trial "good news" for patients, because the study shows many can avoid or defer angioplasty.

The study exposed a rift among heart doctors. On one side are those who champion treating artery disease with drugs, including aspirin, statins and blood pressure reducers that affect every blood vessel. On the other are those who use angioplasty to relieve chest pain by clearing one blockage at a time.

But angioplasty is costly. About 1.2 million angioplasties are done a year. More than half are done to patients with chronic chest pain, such as those in the study.

The initial cost per patient is about $8,000, said William Weintraub of Christiana Hospital in Newark, Del. The cost of each quality year of life gained by angioplasty tops $200,000, four times the average considered reasonable for medical technology, according to his research.

Since each angioplasty costs $5,295 more than drug therapy, eliminating 350,000 could save as much as $10 billion a year, Weintraub says.

A leading angioplasty backer, Greg Stone of Columbia University, downplayed the findings. Angioplasties always have been performed in stable chest pain patients to relieve pain, not prolong life, he said. But Boden counters: Most physicians today believe "angioplasty does alter prognosis."

After an average of five years, 211 deaths and heart attacks occurred in the angioplasty group and 202 in the drug group, researchers told the American College of Cardiology. The findings also appear online in The New England Journal of Medicine.

Researchers also found drugs alone eased pain almost as well as angioplasty. By five years, 74% of those in the angioplasty group said they pain free, compared with 72% of those who took drugs alone. (USA Today)

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Chinese restaurant food unhealthy, study says

Menus loaded with sodium, saturated fat and calories — even the veggies

The typical Chinese restaurant menu is a sea of nutritional no-nos, a consumer group in Washinton has found.

A plate of General Tso’s chicken, for example, is loaded with about 40 percent more sodium and more than half the calories an average adult needs for an entire day.

The battered, fried chicken dish with vegetables has 1,300 calories, 3,200 milligrams of sodium and 11 grams of saturated fat.

That’s before the rice (200 calories a cup). And after the egg rolls (200 calories and 400 milligrams of sodium).

"I don’t want to put all the blame on Chinese food," said Bonnie Liebman, nutrition director of the Center for Science in the Public Interest, which did a report released last week.

"Across the board, American restaurants need to cut back on calories and salt, and in the meantime, people should think of each meal as not one, but two, and bring home half for tomorrow," Liebman said.

The average adult needs around 2,000 calories a day and 2,300 milligrams of salt, which is about one teaspoon of salt, according to government guidelines.

Sheila Weiss, director of nutrition policy at the National Restaurant Association, said that restaurants around the country were already making efforts to offer customers healthier choices. In particular, Chinese restaurants typically offer plenty of options for customers looking to steer clear of fried foods and heavy sauces, she noted.

"Restaurants have a responsibility to provide options and they do," said Weiss, but "customers also have a responsibility to understand their own dietary needs and know how to make special requests."

In some ways, CSPI's Liebman said, Italian and Mexican restaurants are worse for your health, because their food is higher in saturated fat, which can increase the risk of heart disease.

While Chinese restaurant food is bad for your waistline and blood pressure — sodium contributes to hypertension — it does offer vegetable-rich dishes and the kind of fat that’s not bad for the heart.

However — and this is a big however — the veggies aren’t off the hook. A plate of stir-fried greens has 900 calories and 2,200 milligrams of sodium. And eggplant in garlic sauce has 1,000 calories and 2,000 milligrams of sodium.

"We were shocked. We assumed the vegetables were all low in calories," Liebman said.

No safe harbor
Also surprising were some appetizers: An order of six steamed pork dumplings has 500 calories, and there’s not much difference, about 10 calories per dumpling, if they’re pan-fried.

The group found that not much has changed since it examined Chinese food 15 years ago. That’s not all bad, Liebman said.

"We were glad not to find anything different," she said. "Some restaurant food has gotten a lot worse. Companies seem to pile on. Instead of just cheesecake, you get coconut chocolate chip cheesecake with a layer of chocolate cake, and lasagna with meatballs."

The group says there is no safe harbor from sodium on the Chinese restaurant menu, but it offers several tips for making a meal healthier:

Look for dishes that feature vegetables instead of meat or noodles. Ask for extra broccoli, snow peas or other veggies.

Steer clear of deep-fried meat, seafood or tofu. Order it stir-fried or braised.

Hold the sauce, and eat with a fork or chopsticks to leave more sauce behind.

Avoid salt, which means steering clear of the duck sauce, hot mustard, hoisin sauce and soy sauce.

Share your meal or take half home for later.

Ask for brown rice instead of white rice. (AP)

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