Five-decade national trends and forecasting of brain tumor mortality among older adults in the United States, 1968–2035.

Abstract

e14051 Background: Malignant brain tumors remain a major contributor to neurologic mortality in older adults. Despite advances in neurosurgery, radiation therapy, and systemic treatments, contemporary population-level evaluations of long-term mortality trajectories are limited. Characterizing national trends and future burden is critical for healthcare planning and addressing emerging disparities. We evaluated five-decade mortality patterns and projected future trends of malignant brain tumor–related deaths among U.S. adults aged ≥65 years. Methods: We conducted a retrospective population-based analysis using the CDC Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database from 1968–2023. Deaths attributed to malignant brain tumors were identified using ICD-8 (191), ICD-9 (191), and ICD-10 (C71) codes. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by age group, sex, race/ethnicity, U.S. census region, state, and urban–rural classification. Temporal trends were assessed using Joinpoint regression to estimate average annual percent change (AAPC) with 95% confidence intervals (CI). Mortality projections through 2035 were generated using autoregressive integrated moving average (ARIMA) time-series models with diagnostic validation. Results: Between 1968 and 2023, 311,680 malignant brain tumor–related deaths occurred among adults aged ≥65 years. The overall mean AAMR was 15.2 per 100,000, increasing steadily and peaking at 18.3 in 2021 (AAPC: 1.90%; 95% CI: 1.6–2.2). Forecast modeling projected continued elevation in mortality burden, with AAMR reaching 18.06 by 2035 (p<0.00001), supported by satisfactory model performance (ADF p=0.63; Ljung–Box p=0.30). Although males demonstrated higher overall mortality compared with females (mean AAMR: 18.7 vs 12.6), mortality acceleration was greater among females (AAPC: 1.94% vs 1.82%). The 65–74-year age group accounted for the highest absolute burden (167,418 deaths). Racial disparities were observed, with non-Hispanic Black individuals exhibiting the steepest mortality increase (AAPC: 2.70%), followed by White individuals (AAPC: 1.96%). Regionally, the South demonstrated the fastest rising trend (AAPC: 2.19%), while Vermont exhibited the highest state-level mortality burden (AAMR: 23.5 per 100,000). Conclusions: Over the past five decades, malignant brain tumor mortality among older U.S. adults has risen significantly and is projected to remain elevated through 2035. Accelerating trends among women, Black populations, and Southern regions highlight widening disparities in neuro-oncologic outcomes. These findings underscore the urgent need for targeted early detection strategies, equitable access to specialized neuro-oncology care, and resource allocation planning to address the growing aging-related brain tumor burden.