撒哈拉以南非洲地区迫切需要提高乳腺癌的生存率。地理空间障碍会延迟诊断和治疗，但它们对这些环境中生存的影响尚不清楚。我们检查了非洲乳腺癌 - 结果差异队列中 4 年生存率的地理空间差异。在这项前瞻性队列研究中，从纳米比亚、尼日利亚、南非的 8 家医院招募了新诊断患有乳腺癌的女性（年龄≥18 岁） 、乌干达和赞比亚。他们在采访者填写的问卷中报告了社会人口统计信息，并从病历中收集了他们的临床和治疗数据。每三个月联系参与者或其近亲以确定生命状况。主要结局是与农村与城市居住地、直线距离和建模前往医院时间相关的全因死亡率，使用限制平均生存时间、Cox 比例风险和灵活的参数生存模型进行分析。 2228 名乳腺癌女性招募时间为2014年9月8日至2017年12月31日。127人被排除在分析之外（58人患有潜在的癌症复发、之前接受过治疗或没有随访；14人来自样本量较小的少数族裔；55人来自样本量较小的少数民族）。缺少地理编码的家庭地址）。在纳入分析的 2101 名女性中，928 名 (44%) 居住在农村地区。 1042名患者在诊断后4年内死亡；农村地区女性的 4 年生存率为 39% (95% CI 36-42)，而城市地区女性的 4 年生存率为 49% (46-52)（未经调整的风险比 [HR] 1·24 [95% CI 1·09-1] ·40]）。在 734 名居住距离医院超过 1 小时的妇女中，农村地区妇女的粗 4 年生存率为 37%（95% CI 32-42），而城市地区妇女的粗 4 年生存率为 54%（46-62）（HR 1·35 [95% CI 1·07-1·71]（调整年龄、分期和治疗状态后）。在农村地区的妇女中，死亡率随着距离（调整后的心率每 50 公里 1·04、1·01-1·07）和旅行时间（调整后的心率每 50 公里 1·06、1·02-1·10）而增加。在接受治疗的早期乳腺癌女性中，农村地区的女性生存处于明显劣势（根据年龄和分期调整后的总体 HR 1·54、1·14-2·07；>1 小时距离调整后的 HR 2·14、 1·21-3·78).地理空间障碍降低了撒哈拉以南非洲乳腺癌患者的生存率。需要特别关注支持生活在远离癌症治疗设施的农村地区的早期乳腺癌患者。美国国立卫生研究院（国家癌症研究所）、Susan G Komen for the Cure 和国际癌症研究机构。版权所有 © 2024 世界卫生组织。由爱思唯尔有限公司出版。保留所有权利。这是一篇根据 CC BY 3.0 IGO 许可证发布的开放获取文章，允许在任何媒体上不受限制地使用、分发和复制，前提是正确引用了原始作品。在使用本文时，不应暗示世卫组织认可任何特定组织、产品或服务。不允许使用世界卫生组织标志。此通知应与文章的原始 URL 一起保存。

There is an urgent need to improve breast cancer survival in sub-Saharan Africa. Geospatial barriers delay diagnosis and treatment, but their effect on survival in these settings is not well understood. We examined geospatial disparities in 4-year survival in the African Breast Cancer-Disparities in Outcomes cohort.In this prospective cohort study, women (aged ≥18 years) newly diagnosed with breast cancer were recruited from eight hospitals in Namibia, Nigeria, South Africa, Uganda, and Zambia. They reported sociodemographic information in interviewer-administered questionnaires, and their clinical and treatment data were collected from medical records. Vital status was ascertained by contacting participants or their next of kin every 3 months. The primary outcome was all-cause mortality in relation to rural versus urban residence, straight-line distance, and modelled travel time to hospital, analysed using restricted mean survival time, Cox proportional hazards, and flexible parametric survival models.2228 women with breast cancer were recruited between Sept 8, 2014, and Dec 31, 2017. 127 were excluded from analysis (58 had potentially recurrent cancer, had previously received treatment, or had no follow-up; 14 from minority ethnic groups with small sample sizes; and 55 with missing geocoded home addresses). Among the 2101 women included in analysis, 928 (44%) lived in a rural area. 1042 patients had died within 4 years of diagnosis; 4-year survival was 39% (95% CI 36-42) in women in rural areas versus 49% (46-52) in urban areas (unadjusted hazard ratio [HR] 1·24 [95% CI 1·09-1·40]). Among the 734 women living more than 1 h from the hospital, the crude 4-year survival was 37% (95% CI 32-42) in women in rural areas versus 54% (46-62) in women in urban areas (HR 1·35 [95% CI 1·07-1·71] after adjustment for age, stage, and treatment status). Among women in rural areas, mortality rates increased with distance (adjusted HR per 50 km 1·04, 1·01-1·07) and travel time (adjusted HR per h 1·06, 1·02-1·10). Among women with early-stage breast cancer receiving treatment, women in rural areas had a strong survival disadvantage (overall HR 1·54, 1·14-2·07 adjusted for age and stage; >1 h distance adjusted HR 2·14, 1·21-3·78).Geospatial barriers reduce survival of patients with breast cancer in sub-Saharan Africa. Specific attention is needed to support patients with early-stage breast cancer living in rural areas far from cancer treatment facilities.US National Institutes of Health (National Cancer Institute), Susan G Komen for the Cure, and the International Agency for Research on Cancer.Copyright © 2024 World Health Organization. Published by Elsevier Ltd. All rights reserved. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.