Highlight HEALTH

Everyone knows that a good education is important for getting a good job. Now researchers are finding that being well-educated can lengthen your life. The study, published earlier this month in the journal PLoS ONE, finds that socioeconomic inequalities in the U.S. death rate between people with less than a high school education and college graduates increased from 1993 to 2001 [1]. The widening gap is due to (i) significant decreases in mortality from all causes, heart disease, cancer, stroke and other conditions, in the most educated and (ii) unchanged or increasing death rates in the least educated.

Epidemiologists at the American Cancer Society (ACS) worked with scientists from the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) to analyze over 3.5 million deaths from 1993 to 2001. They used data from the National Vital Statistics System (NVSS) and death certificate information to calculate annual age-standardized death rates for 25 — 64 year olds by level of education for all causes of death as well as for the seven most common causes of death (heart disease, cancer, stroke, HIV infection, diabetes, chronic lung disease, accidents).

The study restricted the analyses to deaths among non-Hispanic whites and blacks. It also excluded deaths that occurred in seven states (Georgia, Kentucky, New York, Oklahoma, Rhode Island, South Dakota and West Virginia) because completeness of education on death certificates in these states was less than 80% in at least one of years considered in the study.

The study found that between 1993 and 2001, the ratio of the all cause death rate in people with less than 12 years versus greater than or equal to 16 years of education significantly increased in white and black men, and in white women, indicating that those with a college education or better had an increased life expectancy. Contributing to the inequality was significant reductions in mortality for the most educated men (36% in black men and 25% in white men), largely due to decreases in death rates from HIV infection, cancer and heart disease.

Interestingly, the decrease in all cause death rates among men became larger with each additional increment of educational attainment (i.e. 12 years of education vs. 13 — 15 years vs. greater than or equal to 16 years). In women, this affect was only observed with greater than or equal to 16 years of education.

The study results support a previous investigation of county-level mortality published last month showing a steady increase in mortality inequality across the U.S. [2]. In that study, death rates between 1983 and 1999 increased for women in a large number of counties, principally due to chronic diseases related to smoking, overweight and diabetes, and high blood pressure. Most counties that showed a worsening of life expectancy were in the deep South, along the Mississippi River and in the Appalachia, extending into the southern portion of the Midwest and into Texas.

Between 1961 and 1983, counties with increased or decreased life expectancy improvements had relatively similar levels of income. However, after 1983, gain in life expectancy was positively associated with county income. Thus, those who were disadvantaged did not benefit from the increase in life expectancy experienced by the advantaged, demonstrating a large health inequality.

What does all this mean? It means those with less education are getting left behind and literally dying earlier as a result. ACS chief executive officer Dr. Otis W. Brawley, M.D. said that [3]:

People [in the U.S.] with less education have fewer financial resources, less access to health insurance or stable employment, and less health literacy. As a result, while the death rate among the most educated Americans is dropping dramatically, we’re seeing a real lack of progress or even worsening trends in the least educated persons. The gap between the best and worst off in the country is actually getting wider.

Last year, the American Cancer Society launched the Access to Health Care campaign, a national initiative to raise awareness about the problem of true access to health care. The website shows what is being done to help those uninsured and underinsured and how you can help.

Education is a marker of socioeconomic position. Lower educational attainment and thus a poorer socioeconomic position is associated with a variety of factors that affect health, including decreased financial resources, reduced access to health insurance and health literacy. Given that one of the CDC’s strategic imperatives is “all people, and especially those at greater risk of health disparities, will achieve their optimal lifespan with the best possible quality of health in every stage of life” [4], these results are troubling and highlight the growing problem with the U.S. healthcare system.

References

1. Jemal et al. Widening of socioeconomic inequalities in U.S. death rates, 1993-2001. PLoS ONE. 2008 May 14;3(5):e2181. DOI: 10.1371/journal.pone.0002181
   View abstract
2. Ezzati et al. The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States. PLoS Med. 2008 Apr 22;5(4):e66.
   View abstract
3. Worsening Health Trends Among Least Educated. American Cancer Society News Center. 2008 May 14.
4. Center for Disease Control and Prevention’s Health Protection Goals. Accessed 2008 Jun 2.

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A good night’s sleep is increasingly loosing out to late night television, the internet, video games and other modern day distractions, and our health is taking the toll. An estimated 50 to 70 million people suffer from chronic sleep loss and sleep disorders, and loss of sleep is associated with a variety of health problems, including obesity and depression [1]. According to a recent four state study by the Centers for Disease Control and Prevention (CDC), 70% of adults report not getting enough rest or sleep at least once over the past month; 10% report insufficient rest or sleep every day [2].

The CDC analyzed 2006 Behavioral Risk Factor Surveillance System (BRFSS) data from four states, Delaware, Hawaii, New York and Rhode Island. The study, one of the first to present state-level information on any sleep-related measure, found that the prevalence of insufficient sleep was greater in young adults. Of those ages 18 — 34, 13.3% reported insufficient rest or sleep every day over the past month. Of those aged of 35 — 54, only 10% reported insufficient rest or sleep every day over the past month. The percentage was smallest (7.3%) for those aged ≥ 55 years. Similar trends were observed for shorter periods of time. Interestingly however, for people reporting only 1 — 6 days of insufficient rest or sleep during the preceding 30 days, young adults had the lowest percentage (27.8%), while adults aged 35 — 44 had the highest percentage (38.2%), followed by adults aged 45 — 54 (36%) and people aged ≥ 55 years (31.7%).

Persons unable to work were significantly more likely to report insufficient rest or sleep everyday than people employed, students or homemakers, people unemployed or people retired. With increasing education, respondents were less likely to report no days of insufficient rest or sleep.

The study is subject to a number of limitations. Chief among them is that it uses the results of a survey. The principle limitations of a survey are the validity and reliability of responses. Poor recall, intentional deception and misunderstanding can all contribute to inaccuracies in the data. The survey method is also descriptive and cannot offer insights into cause-and-effect relationships. Lastly, the data only reflects sleep trends in four states and may not be representative of the entire United States. Nevertheless, it is consistent with another CDC study using data from the National Health Interview Study, which found that the percentage of adults at all ages reporting six hours or less of sleep per night increased from 1985 to 2006 [3].

According to the National Sleep Foundation, most healthy adults require 7 to 9 hours of sleep each night [4]. Children and adolescents need even more sleep than adults. Children aged 3 — 5 years require 11 to 13 hours of sleep each night, children aged 5 — 12 require 9 to 11 hours and adolescents require 8.5 to 9.5 hours [4].

Here’s some tips to get a good night’s sleep:

• Keep your room quiet and dark
• Make sure your bed is comfortable
• Avoid or limit caffeine and alcohol consumption
• Don’t smoke
• Eat dinner at least 2 — 3 hours before bedtime
• Relax prior to bedtime
• Don’t exercise right before bedtime
• Establish regular bedtime and waketime schedule

Additional information on sleep and sleep disorders can be found at The National Sleep Foundation, Sleep Education.com and The Insomnia blog.

The results of this study should come as no surprise, especially to many of you who are undoubtedly reading this late in the evening. How about you? Do you get enough sleep every night?

References

1. Institute of Medicine. Sleep disorders and sleep deprivation: an unmet public health problem. By the Committee on Sleep Medicine and Research. Edited by Harvey R. Colten and Bruce M. Altevogt. 404 pp. Washington, DC, National Academies Press, 2006.
2. Centers for Disease Control and Prevention (CDC). Perceived insufficient rest or sleep–four states, 2006. MMWR Morb Mortal Wkly Rep. 2008 Feb 29;57(8):200-3.
   View abstract
3. QuickStats: Percentage of Adults Aged >18 Years Who Reported an Average of <6 Hours of Sleep per 24-Hour Period, by Sex and Age Group — National Health Interview Survey, United States, 1985 and 2006. MMWR Morb Mortal Wkly Rep. 2008 Feb 29;57(8):209.
4. How Much Sleep is Enough? National Sleep Foundation. Accessed 2008 May 6.

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Last Sunday, 60 Minutes profiled John Kanzius, an inventor who may have come up with one of the most promising breakthroughs in cancer research in years. It’s still in the experimental stage and much research needs to be done, but if future clinical trials are successful, the Kanzius Machine will destroy cancer cells throughout the body without need for drugs or surgery.

John Kanzius was diagnosed with terminal leukemia six years ago. Watching children endure difficult chemo treatments while he was undergoing his own chemotherapy motivated him to come up with an alternative. At the start of his interview with 60 Minutes correspondent Lesley Stahl, he said [1]:

I have no business being in the cancer business. It’s not something that a layman like me should in, it should be left to doctors and research people.
[Lesley Stahl: But sometimes it takes an outsider.]
Sometimes it just — maybe you get lucky.

And lucky he has been. Kanzius is a retired radio technician and station owner. As an alternative to chemotherapy, his idea was to build a radio-wave machine that focused radio waves to destroy cancer cells. Kanzius knew that strong radio waves could heat metal and wondered if metal injected in a tumor would heat up when placed in a radio-wave field, thereby killing the cells. Following initial experiments with a garage-built prototype, he spent about $200,000 to have an advanced version of his radio-wave machine built. Using hotdogs injected with copper sulfate (an aqueous metal solution), Kanzius found that he could heat up small regions injected with the metal by placing them in a radio-wave field, leaving surrounding areas unharmed.

Dr. Steven Curley and colleagues at the MD Anderson Cancer Center have begun testing Kanzius’ radio-wave technology on animals. Instead of copper sulfate, the researchers are using single-walled carbon nanotubes — molecular-scale tubes of graphitic carbon that, among other unique properties, are efficient conductors of heat. The nanoparticles are so small, thousands of them can fit inside a single cell. In a paper published in the December 2007 issue of the journal Cancer, the researchers demonstrated that, when exposed to a non-invasive radiofrequency (RF) field, an aqueous suspension of carbon nanotubes injected in malignant liver cancer tumors in rabbits produced lethal thermal injury to cancer cells [2]. The controls, tumors exposed only to the RF field or only to the nanotubes, were undamaged. However, some healthy liver tissue surrounding the cancerous tissue sustained heat damage due to nanotube leakage from the tumor.

Thus far, the technique has only been used on solid, localized tumors in animals by injection. The next step is to evaluate methods for targeting the nanotubes so they attach to and are taken up by cancer cells and not normal cells. According to Curley, the targeting of nanotubes to cancer cells and not to normal cells is a major challenge in advancing the therapy [3]. Researchers are looking to bind the nanotubes to antibodies, peptides or other agents that would target molecules expressed exclusively on cancer cells.

Gold nanoparticles have also been shown recently to enhance non-invasive RF thermal destruction of human gastrointestinal cancer cells in vitro [4].

Dr. Curley estimates that human clinical trials are at least three to four years away [3]. Using physics-based concepts, the Kanzius Machine is a potential new cancer treatment that may one day replace chemotherapy and surgery. That said, remember that many cancer therapies that have been promising in vitro and in animal models didn’t work in humans. There is zero evidence this will work in humans and targeting is a major issue that has to be overcome first.

References

1. The Kanzius Machine: A Cancer Cure? 60 Minutes. 2008 Apr 13.
2. Gannon et al. Carbon nanotube-enhanced thermal destruction of cancer cells in a noninvasive radiofrequency field. Cancer. 2007 Dec 15;110(12):2654-65.
   View abstract
3. Radio Waves Fire Up Nanotubes Embedded in Tumors, Destroying Liver Cancer. M.D. Anderson News Release. 2007 Nov 1.
4. Gannon et al. Intracellular gold nanoparticles enhance non-invasive radiofrequency thermal destruction of human gastrointestinal cancer cells. J Nanobiotechnology. 2008 Jan 30;6:2.
   View abstract

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