title: Pollution, Poverty, and Potentially Preventable Childhood Morbidity in Central California.
abstract: OBJECTIVE
  To measure ecological relationships between neighborhood pollution burden, poverty, race/ethnicity, and pediatric preventable disease hospitalization rates.
  
  
  METHODS
  Preventable disease hospitalization rates were obtained from the 2012 California Office of Statewide Health Planning and Development database, for 8 Central Valley counties. US Census Data was used to incorporate zip code level factors including racial diversity and poverty rates. The pollution burden score was calculated by the California Office of Environmental Health Hazard Assessment using 11 indicators. Poisson-based negative binomial regression was used for final analysis. Stratification of sample by age, race/ethnicity, and insurance coverage was also incorporated.
  
  
  RESULTS
  Children experiencing potentially preventable hospitalizations are disproportionately low income and under the age of 4 years. With every unit increase in pollution burden, preventable disease hospitalizations rates increase between 21% and 32%, depending on racial and age subgroups. Although living in a poor neighborhood was not associated with potentially avoidable hospitalizations, children enrolled in Medi-Cal who live in neighborhoods with lower pollution burden and lower levels of poverty, face 32% lower risk for ambulatory care sensitive condition hospitalization. Children living in primary care shortage areas are at increased risk of preventable hospitalizations. Preventable disease hospitalizations increase for all subgroups, except white/non-Hispanic children, as neighborhoods became more racially diverse.
  
  
  CONCLUSIONS
  Understanding the geographic distribution of disease and impact of individual and community level factors is essential to expanding access to care and preventive resources to improve the health of children in California's most polluted and underserved region.
authors.affiliation: Central Valley Health Policy Institute, Central California Center for Health and Human Service, California State University-Fresno, Fresno, CA. Electronic address: llessard@csufresno.edu.
authors.forename: Lauren N
authors.initials: LN
authors.lastname: Lessard
authors.affiliation: Central Valley Health Policy Institute, Central California Center for Health and Human Service, California State University-Fresno, Fresno, CA.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Alcala
authors.affiliation: Central Valley Health Policy Institute, Central California Center for Health and Human Service, California State University-Fresno, Fresno, CA.
authors.forename: John A
authors.initials: JA
authors.lastname: Capitman
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002140:California; D002648:Child; D002675:Child, Preschool; D004787:Environmental Pollution; D005006:Ethnicity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D009017:Morbidity; D010372:Pediatrics; D011203:Poverty; D011320:Primary Health Care; D011322:Primary Prevention; D044469:Racial Groups; D012111:Residence Characteristics; D012189:Retrospective Studies