Comparative mortality burden of primary brain malignancies versus brain metastases in the United States.

Abstract

e14011 Background: Primary brain malignancies and brain metastases represent major contributors to neurological morbidity and mortality among cancer patients in the United States. Analyzing two decades of CDC WONDER data provides insights into mortality disparities and demographic variations. Methods: Using the CDC WONDER database for adults aged ≥25, we analyzed age-adjusted and crude mortality rates (AAMRs and CMRs) per 100,000 for primary brain malignancies (ICD-10) and brain metastasis (ICD-10) by year, sex, race/ethnicity, and geography. Joinpoint regression estimated average annual percentage change (AAPC) and annual percentage change (APC) with 95% confidence interval (CIs). Results: The overall mortality related to brain metastasis has declined more steeply compared to primary brain malignancies (AAPC: –0.76 vs –0.13). Primary brain malignancies showed a significant decline between 1999 and 2006 (APC: −1.18; 95% CI: −1.74 to −0.61), followed by a modest long-term increase. In contrast, brain metastases had a steep initial decline from 1999 to 2007 (APC: −4.46; 95% CI: −4.87 to −4.04), followed by sharp increases from 2013-2016 (APC: 4.03; 95% CI: 0.05 to 8.17) and from 2016-2023 (APC: 1.42; 95% CI: 0.95 to 1.89). The annual change in mortality among female patients was not significant for either cause, whereas among men, the decline in mortality related to brain metastases (AAPC: −1.18; p<0.001) was steeper compared with primary brain malignancies (AAPC: −0.32; p=0.02), with the most significant decline observed between 1999 and 2007 (APC: −5.08; 95% CI: −5.62 to −4.53). When stratified by race, the NH Black or African American population showed an overall significant decline in mortality related to brain metastases (AAPC: −1.42; p<0.001), while overall change was non-significant among all other racial groups. For primary brain malignancies, overall mortality increased notably in the NH Asian or Pacific Islander population (AAPC: 1.06; p<0.001). Conclusions: Mortality related to brain metastases has declined more steeply than primary brain malignancies over the past two decades; however, recent increases and demographic disparities highlight the need for targeted interventions and equitable access to neurological care. Average annual percentage changes (AAPC) per 100,000 for trends related to primary brain malignancies and brain metastases from 1999 to 2023. Variable AAPC (95%CI) for Primary Brain Malignancy AAPC (95%CI)for Brain Metastasis Overall -0.13(-0.31 to 0.04) -0.76(-1.29 to -0.24) Male -0.32(-0.62 to -0.03) -1.18(-1.58 to -0.77) Female -0.14(-0.33 to 0.03) -0.37(-0.97 to 0.23) NH Blacks 0.12 (-0.46 to 0.72) -1.42(-1.89 to -0.95) NH Asians 1.06 (0.62 to 1.50) 0.59(-0.32 to 1.52) NH Americans -0.16 (-1.17 to 0.85) 0.45(-0.27 to 1.18) NH Whites 0.12 (-0.02 to 0.28) -0.47(-1.05 to 0.10) Hispanic or Latinos -0.06 (-0.78 to 0.64) -0.32(-1.02 to 0.37)