Christo Albor
I'm a London-based epidemiologist. I am currently also training in Medicine. My PhD thesis was about health inequalities in the UK.
My active research projects are:
- The mental health of poor people and ethnic minorities living in affluent areas (started 2012). This is a collaboration led by myself involving a psychiatrist at the Royal Free hospital (London), a fellow medical student at Barts and The London (London), and an epidemiologist at Manchester.
- Creating a cohort of people with multiple sclerosis in East London (started 2012). This is a collaboration led by a consultant neurologist at the Royal London hospital. We are utilising various sources of information, including hospital electronic records to improve the characterisation of multiple sclerosis in East London.
- The sustainability of London's geographic inequalities (started 2011). This is a collaboration led by Sir Michael Marmot (UCL, WHO) which was originally destined to be a chapter for a book on London's sustainability. The people involved have focused on socioeconomic and ethnic geographical inequality.
Examples of my previous projects include:
- Co-authored systematic and narrative reviews of neighbourhood effects on health related to ethnicity and socioeconomic status (Started 2009 & Published two papers in 2012).
- Co-authored chapter on health inequalities in a book on youth-related political ideas (Started 2011 & Published 2012).
- PhD thesis: "Are Poor People Healthier in Rich or Poor Areas? The Psychosocial Effects of Socioeconomic Incongruity in the Neighbourhood" (Started 2007 & Completed 2011).
Supervisors: Dimitris Ballas, Kate Pickett, Richard Wilkinson, and Mai Stafford
Address: London
My active research projects are:
- The mental health of poor people and ethnic minorities living in affluent areas (started 2012). This is a collaboration led by myself involving a psychiatrist at the Royal Free hospital (London), a fellow medical student at Barts and The London (London), and an epidemiologist at Manchester.
- Creating a cohort of people with multiple sclerosis in East London (started 2012). This is a collaboration led by a consultant neurologist at the Royal London hospital. We are utilising various sources of information, including hospital electronic records to improve the characterisation of multiple sclerosis in East London.
- The sustainability of London's geographic inequalities (started 2011). This is a collaboration led by Sir Michael Marmot (UCL, WHO) which was originally destined to be a chapter for a book on London's sustainability. The people involved have focused on socioeconomic and ethnic geographical inequality.
Examples of my previous projects include:
- Co-authored systematic and narrative reviews of neighbourhood effects on health related to ethnicity and socioeconomic status (Started 2009 & Published two papers in 2012).
- Co-authored chapter on health inequalities in a book on youth-related political ideas (Started 2011 & Published 2012).
- PhD thesis: "Are Poor People Healthier in Rich or Poor Areas? The Psychosocial Effects of Socioeconomic Incongruity in the Neighbourhood" (Started 2007 & Completed 2011).
Supervisors: Dimitris Ballas, Kate Pickett, Richard Wilkinson, and Mai Stafford
Address: London
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Books by Christo Albor
The incapacity of the major political parties in Britain to think beyond their short-term electoral interests is, by definition, particularly harmful for those at the beginning of their lives. It has led to a failure to act on climate change, savage cutbacks in education and training, an acute shortage of housing, big cuts in youth services, and, for many, the prospect of an old age without pensions. Things have deteriorated to the point where many young people are finding it impossible to find the wherewithal to settle down and have families - the classic marks of adulthood.
But, as Shiv Malik argues in his preface, a diagnosis of the problem does not absolve the young from taking responsibility for developing solutions. We need more than 'a whinge of epic proportions'. And, as he also points out, the young are well placed to develop alternatives: 'we are the most well-educated, innovative, dynamic and open generation in human history'. This means that this book also has plenty of ideas for changing the future.
Papers by Christo Albor
Objectives: To provide updated ethnicity-specific MS prevalence rates in the United Kingdom. Methods: Electronic records from general practices (GPs) in four east London boroughs were queried for the number of people diagnosed with MS, grouped by ethnicity, into 5-year age bands. Compared against total registered GP patients in the area (c. 900,000), the age-standardised MS prevalence was calculated by ethnic group.
Results: The overall age-standardised prevalence of MS was 111 per 100,000 (152 for women and 70 for men), and 180, 74 and 29 for the White, Black and South Asian populations, respectively. The sex ratios (female:male) were 2.2:1, 2.1:1 and 2.8:1, respectively.
Conclusion: MS prevalence was considerably lower among Black and South Asian populations, com- pared to the White population, by 59% and 84%, respectively. However, compared to available data in Africa and South Asia, MS is several times more prevalent among Black people and South Asians living in the United Kingdom than their territorial ancestry.
The ‘ethnic density hypothesis’ is a proposition that members of ethnic minority groups may have better mental health when they live in areas with higher proportions of people of the same ethnicity. Investigations into this hypothesis have resulted in a complex and sometimes disparate literature.
Aims
Systematically identify relevant studies, summarise their findings in a narrative synthesis, and discuss potential explanations of the associations found between ethnic density and mental disorders.
Method
A narrative review of studies published up to January 2011, identified through a systematic search strategy. Studies included have a defined ethnic minority sample; some measure of ethnic density defined at a geographical scale smaller than a nation or a US state; and a measure ascertaining mental health or disorder. Analysis was by narrative synthesis with the aid of semi-quantitative visualisation of data.
Results
Thirty four papers from 29 datasets were identified. Protective associations between ethnic density and diagnosis of mental disorders were most consistent in older US ecological studies of admission rates. Among more recent multilevel studies, there was some evidence of ethnic density being protective against depression and anxiety for African Americans and Hispanic adults in the US. However, Hispanic, Asian-American and Canadian ‘visible minority’ adolescents suffer higher levels of depression at higher ethnic densities. Studies in the UK showed mixed results, with evidence for protective associations most consistent for psychoses.
Conclusions
The results of this review indicate that the most consistent associations of ethnic density are found for psychoses. Ethnic density may also protect against other mental disorders, but presently, as most studies of ethnic density have limited statistical power, and given the heterogeneity of their study designs, our conclusions can only be tentative.
Highlights
► A detrimental association between area deprivation and poor self-rated health was found across all ethnic groups.
► However, area deprivation was less strongly associated for ethnic minority people, as compared to white British people.
► Local service satisfaction, neighbourhood disorder, and collective effects did not mediate this differential association.
"In April last year, The New York Times published an article with the title ‘Maybe Money Does Buy Happiness After All’ (Leonhardt, 2008). A month later, the Times of London followed suit with, ‘If you’re richer, you’re happier’ (Finkelstein, 2008). As suggested by their titles, these articles reported that more money equals more happiness. The source for this assertion was a recent paper by two economists, Betsey Stevenson and Justin Wolfers (2008) who purport to refute the long- standing claim, commonly attributed to Richard Easterlin, that money does not ‘buy’ happiness.
"In this essay I consider the validity of the journalists’ reports by reviewing the findings of Stevenson and Wolfers. If indeed their statements have been too bold, I offer potential explanations for the diminishing effect of national economy on happiness. I expand with a wider framework of well-being by including the economy’s effects on health. This is in light of the fact that both health and happiness are affected by the economic and social environment in similar ways. Thus, an examination of the literature on health and its shared social determinants with happiness may help to settle the dispute."
Talks by Christo Albor
Design: Cross-sectional analysis of 14 465 white mothers surveyed in the first wave of the Millennium Cohort Study, 3654 of these mothers were defined as poor. The socio-economic context for poor mothers was measured by lower super output area (LSOA)-level measures of income. UK-wide analyses used the LSOA decile ranks of the index of multiple deprivation (IMD) income domain. A subset England-only analysis of 7288 mothers used continuous IMD income domain scores.
Outcome Measures: Maternal self-rated health and limiting long- term illness (LLI), low birthweight (LBW), and preterm delivery. Logistic regression models were run separately for poor (,£10 400) and non-poor households. Models were adjusted for age, marital status, parity, urban status, duration at address, occupational class and educational attainment
Results: For poor mothers, odds for LBW and LLI increased with every decile of area income, by 9% and 8% respectively (p,0.05 all models). This contrasted with findings for non-poor mothers – for whom odds decreased 6% and 5% respectively (not significant for LLI). In the subset England-only analysis, for poor mothers, area income was positively associated with LLI and LBW but significant only for LLI. Self-rated health did not vary significantly across areas for poor mothers. In contrast, for non-poor mothers, poor/fair self-rated health was negatively associated with area- level income, decreasing by 11% for each area income decile (p,0.001 all models and England subset). Odds of preterm delivery decreased for poor mothers by 7% per decile (p,0.05), but this was not significant for England-only analyses. No models examining area income in relation to preterm delivery were significant for non-poor mothers.
Conclusion: Apart from preterm delivery, health outcomes of non- poor mothers are improved when they live in more affluent areas. This is not the case for poor mothers, who do not have better self- rated health, and who have higher risk of LBW and LLI in richer areas. These findings may support a psycho-social causal model mediated by area socio-economic density. Further work is needed to test mediating pathways such as social engagement and class discrimination."
Conference Posters by Christo Albor
The incapacity of the major political parties in Britain to think beyond their short-term electoral interests is, by definition, particularly harmful for those at the beginning of their lives. It has led to a failure to act on climate change, savage cutbacks in education and training, an acute shortage of housing, big cuts in youth services, and, for many, the prospect of an old age without pensions. Things have deteriorated to the point where many young people are finding it impossible to find the wherewithal to settle down and have families - the classic marks of adulthood.
But, as Shiv Malik argues in his preface, a diagnosis of the problem does not absolve the young from taking responsibility for developing solutions. We need more than 'a whinge of epic proportions'. And, as he also points out, the young are well placed to develop alternatives: 'we are the most well-educated, innovative, dynamic and open generation in human history'. This means that this book also has plenty of ideas for changing the future.
Objectives: To provide updated ethnicity-specific MS prevalence rates in the United Kingdom. Methods: Electronic records from general practices (GPs) in four east London boroughs were queried for the number of people diagnosed with MS, grouped by ethnicity, into 5-year age bands. Compared against total registered GP patients in the area (c. 900,000), the age-standardised MS prevalence was calculated by ethnic group.
Results: The overall age-standardised prevalence of MS was 111 per 100,000 (152 for women and 70 for men), and 180, 74 and 29 for the White, Black and South Asian populations, respectively. The sex ratios (female:male) were 2.2:1, 2.1:1 and 2.8:1, respectively.
Conclusion: MS prevalence was considerably lower among Black and South Asian populations, com- pared to the White population, by 59% and 84%, respectively. However, compared to available data in Africa and South Asia, MS is several times more prevalent among Black people and South Asians living in the United Kingdom than their territorial ancestry.
The ‘ethnic density hypothesis’ is a proposition that members of ethnic minority groups may have better mental health when they live in areas with higher proportions of people of the same ethnicity. Investigations into this hypothesis have resulted in a complex and sometimes disparate literature.
Aims
Systematically identify relevant studies, summarise their findings in a narrative synthesis, and discuss potential explanations of the associations found between ethnic density and mental disorders.
Method
A narrative review of studies published up to January 2011, identified through a systematic search strategy. Studies included have a defined ethnic minority sample; some measure of ethnic density defined at a geographical scale smaller than a nation or a US state; and a measure ascertaining mental health or disorder. Analysis was by narrative synthesis with the aid of semi-quantitative visualisation of data.
Results
Thirty four papers from 29 datasets were identified. Protective associations between ethnic density and diagnosis of mental disorders were most consistent in older US ecological studies of admission rates. Among more recent multilevel studies, there was some evidence of ethnic density being protective against depression and anxiety for African Americans and Hispanic adults in the US. However, Hispanic, Asian-American and Canadian ‘visible minority’ adolescents suffer higher levels of depression at higher ethnic densities. Studies in the UK showed mixed results, with evidence for protective associations most consistent for psychoses.
Conclusions
The results of this review indicate that the most consistent associations of ethnic density are found for psychoses. Ethnic density may also protect against other mental disorders, but presently, as most studies of ethnic density have limited statistical power, and given the heterogeneity of their study designs, our conclusions can only be tentative.
Highlights
► A detrimental association between area deprivation and poor self-rated health was found across all ethnic groups.
► However, area deprivation was less strongly associated for ethnic minority people, as compared to white British people.
► Local service satisfaction, neighbourhood disorder, and collective effects did not mediate this differential association.
"In April last year, The New York Times published an article with the title ‘Maybe Money Does Buy Happiness After All’ (Leonhardt, 2008). A month later, the Times of London followed suit with, ‘If you’re richer, you’re happier’ (Finkelstein, 2008). As suggested by their titles, these articles reported that more money equals more happiness. The source for this assertion was a recent paper by two economists, Betsey Stevenson and Justin Wolfers (2008) who purport to refute the long- standing claim, commonly attributed to Richard Easterlin, that money does not ‘buy’ happiness.
"In this essay I consider the validity of the journalists’ reports by reviewing the findings of Stevenson and Wolfers. If indeed their statements have been too bold, I offer potential explanations for the diminishing effect of national economy on happiness. I expand with a wider framework of well-being by including the economy’s effects on health. This is in light of the fact that both health and happiness are affected by the economic and social environment in similar ways. Thus, an examination of the literature on health and its shared social determinants with happiness may help to settle the dispute."
Design: Cross-sectional analysis of 14 465 white mothers surveyed in the first wave of the Millennium Cohort Study, 3654 of these mothers were defined as poor. The socio-economic context for poor mothers was measured by lower super output area (LSOA)-level measures of income. UK-wide analyses used the LSOA decile ranks of the index of multiple deprivation (IMD) income domain. A subset England-only analysis of 7288 mothers used continuous IMD income domain scores.
Outcome Measures: Maternal self-rated health and limiting long- term illness (LLI), low birthweight (LBW), and preterm delivery. Logistic regression models were run separately for poor (,£10 400) and non-poor households. Models were adjusted for age, marital status, parity, urban status, duration at address, occupational class and educational attainment
Results: For poor mothers, odds for LBW and LLI increased with every decile of area income, by 9% and 8% respectively (p,0.05 all models). This contrasted with findings for non-poor mothers – for whom odds decreased 6% and 5% respectively (not significant for LLI). In the subset England-only analysis, for poor mothers, area income was positively associated with LLI and LBW but significant only for LLI. Self-rated health did not vary significantly across areas for poor mothers. In contrast, for non-poor mothers, poor/fair self-rated health was negatively associated with area- level income, decreasing by 11% for each area income decile (p,0.001 all models and England subset). Odds of preterm delivery decreased for poor mothers by 7% per decile (p,0.05), but this was not significant for England-only analyses. No models examining area income in relation to preterm delivery were significant for non-poor mothers.
Conclusion: Apart from preterm delivery, health outcomes of non- poor mothers are improved when they live in more affluent areas. This is not the case for poor mothers, who do not have better self- rated health, and who have higher risk of LBW and LLI in richer areas. These findings may support a psycho-social causal model mediated by area socio-economic density. Further work is needed to test mediating pathways such as social engagement and class discrimination."