Determining rural risk for aneurysmal subarachnoid hemorrhages: A structural equation modeling approach.
An aneurysmal subarachnoid hemorrhage (aSAH) carries a high disability burden. The true impact of rurality as a predictor of outcome severity is unknown. Our aim is to clarify the relationship between the proposed explanations of regional and rural health disparities linked to severity of outcome following an aSAH. An initial literature search identified limited data directly linking geographical location, rurality, rural vulnerability, and aSAH. A further search noting parallels with ischemic stroke and acute myocardial infarct literature presented a number of diverse and interrelated predictors. Thisa prioriknowledge informed the development of a conceptual framework that proposes the relationship between rurality and severity of outcome following an aSAH utilizing structural equation modeling. The presented conceptual framework explores a number of system, environmental, and modifiable risk factors. Socioeconomic characteristics, modifiable risk factors, and timely treatment that were identified as predictors of severity of outcome following an aSAH and within each of these defined predictors a number of contributing specific individual predictors are proposed. There are considerable gaps in the current knowledge pertaining to the impact of rurality on the severity of outcome following an aSAH. Absent from the literature is any investigation of the cumulative impact and multiplicity of risk factors associated with rurality. The proposed conceptual framework hypothesizes a number of relationships between both individual level and system level predictors, acknowledging that intervening predictors may mediate the effect of one variable on another.
School of Health Sciences, Faculty of Health Science, University of Tasmania, Hobart Tasmania, Australia.
Linda Jayne
LJ
Nichols
Menzies Institute for Medical Research, University of Tasmania, Hobart Tasmania, Australia.
Seana
S
Gall
Menzies Institute for Medical Research, University of Tasmania, Hobart Tasmania, Australia.
Christine
C
Stirling
Aneurysmal subarachnoid hemorrhage; rural vulnerability; structural equation modeling
Circulation. 1999 Sep 14;100(11):1209-14
10484542
Stroke. 2001 May;32(5):1173-5
11340228
Emerg Med J. 2001 Jul;18(4):263-9
11435359
Cerebrovasc Dis. 2001;12(1):7-13
11435673
Stroke. 2002 Jan;33(1):268-73
11779921
Stroke. 2002 May;33(5):1225-32
11988595
J Neurol Neurosurg Psychiatry. 2002 Aug;73(2):185-7
12122180
J Neurosci Nurs. 2003 Aug;35(4):210-4
12942655
Stroke. 2003 Dec;34(12):2781-7
14657543
JAMA. 2004 Feb 18;291(7):866-9
14970066
Circulation. 2004 May 11;109(18):2207-12
15117848
Neuroepidemiology. 2004 Nov-Dec;23(6):299-305
15297797
Am J Public Health. 2004 Oct;94(10):1675-8
15451729
Am J Public Health. 2004 Oct;94(10):1682-6
15451731
Int J Health Geogr. 2004 Sep 29;3(1):21
15456514
Arch Neurol. 2005 Mar;62(3):410-6
15767506
J Rural Health. 2005 Spring;21(2):140-8
15859051
Eval Health Prof. 2005 Sep;28(3):295-309
16123259
Soc Work Health Care. 2005;42(2):73-92
16390837
Surg Neurol. 2006 Apr;65(4):360-5, discussion 365-6
16531194
BMC Med Res Methodol. 2006 Mar 15;6:13
16539711
Lancet Neurol. 2007 Feb;6(2):182-7
17239805
Stroke. 2007 Apr;38(4):1216-21
17322078
BMC Public Health. 2007 Nov 13;7:326
17999764
J Emerg Med. 2008 Apr;34(3):237-51
18155383
Intern Med J. 2008 Dec;38(12):879-86
18284462
Aust J Rural Health. 2008 Apr;16(2):56-66
18318846
Arch Neurol. 2008 Jul;65(7):887-91
18625855
Australas J Ageing. 2008 Jun;27(2):56-60
18713193
Eur J Neurol. 2008 Dec;15(12):1293-9
18795944
South Med J. 2009 Jan;102(1):21-4
19077776
Am J Health Behav. 2009 Sep-Oct;33(5):550-7
19296745
Clin Nurs Res. 2010 Feb;19(1):38-54
19926799
Neurology. 2010 May 11;74(19):1494-501
20375310
Dan Med Bull. 2010 Apr;57(4):A4139
20385080
Stroke. 2010 Aug;41(8):e519-36
20595669
BMC Res Notes. 2010 Oct 22;3:267
20969789
Cerebrovasc Dis. 2011;31(1):57-63
20980755
J Cardiovasc Nurs. 2011 May-Jun;26(3):184-93
21116191
Curr Hypertens Rep. 2011 Jun;13(3):208-13
21327566
Can Rev Sociol. 2010 Nov;47(4):381-403
21553634
Med J Aust. 2011 Jul 4;195(1):10-4
21728934
Circulation. 2011 Jul 19;124(3):314-23
21730306
Psychol Methods. 2011 Sep;16(3):265-84
21767021
Stroke. 2011 Oct;42(10):2896-902
21817140
BMC Public Health. 2012 Jan 25;12:79
22276576
Neurocrit Care. 2012 Dec;17(3):324-33
22311233
BMC Res Notes. 2012 Feb 09;5:89
22321339
Stroke. 2012 Apr;43(4):1186-91
22363052
Indian J Med Sci. 2010 Feb;64(2):85-9
22466498
Stroke. 2012 Jun;43(6):1711-37
22556195
Emerg Med Pract. 2012 Jun;14(6):1-23; quiz 23-4
22830180
Neurocrit Care. 2012 Dec;17(3):312-23
22843190
BMC Public Health. 2012 Aug 01;12:586
22853803
Neurology. 2012 Sep 18;79(12):1230-6
22955127
Clin Neurol Neurosurg. 2013 Jan;115(1):77-81
23128015
Turk Neurosurg. 2012;22(6):675-81
23208896
J Neurol. 2013 Apr;260(4):1052-60
23224052
Stroke. 2013 Jan;44(1):43-54
23250997
Clin Neurol Neurosurg. 2013 Aug;115(8):1304-7
23318019
Aust N Z J Public Health. 2013 Feb;37(1):90
23379812
Acta Neurochir (Wien). 2013 Apr;155(4):579-86
23397308
Int J Stroke. 2015 Jun;10(4):529-33
23489935
Neurol Med Chir (Tokyo). 2013;53(3):157-62
23524499
J Neurol Neurosurg Psychiatry. 2014 Jan;85(1):56-9
23813741
J Public Health Manag Pract. 2013 Sep-Oct;19(5):E23-8
23892384
Stroke. 2013 Oct;44(10):2842-7
23899917
Stroke. 2013 Oct;44(10):2891-3
23899918
PLoS One. 2013 Sep 09;8(9):e73760
24040058
Prof Geogr. 2012 Apr 1;64(2):null
24273346
J Am Coll Surg. 2014 Jan;218(1):51-7
24355876
Neurol Med Chir (Tokyo). 2014 Jun 17;54(6):465-73
24670311
Med J Aust. 2014 Apr 21;200(7):392-3
24794668
J Neurol Surg A Cent Eur Neurosurg. 2015 Jan;76(1):46-55
24819626
PLoS One. 2014 Jun 09;9(6):e99536
24911172
J Clin Neurosci. 2014 Dec;21(12):2088-91
24998859
J Neurointerv Surg. 2015 Nov;7(11):855-60
25200246
Diagnosis (Berl). 2014 Jun;1(2):155-166
28344918
Aust J Rural Health. 1998 Nov;6(4):212-6
9919079