Mortality trends of brain tumors complicated by respiratory failure: National patterns and forecasted burden through 2035.

Abstract

e14050 Background: Acute respiratory failure (ARF) represents the leading indication for intensive care unit (ICU) admission among patients with malignancy and is associated with disproportionately high mortality. Patients with primary brain tumors are uniquely vulnerable due to direct brainstem involvement, elevated intracranial pressure, and impaired ventilatory drive. However, population-level mortality trends evaluating the combined burden of brain tumors and ARF remain poorly characterized. We sought to quantify national mortality patterns and project future disease burden using contemporary U.S. surveillance data. Methods: We analyzed death certificate data from the CDC Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database from 1999–2023. Adults aged ≥45 years with brain tumors (ICD-10 C71) and respiratory failure (ICD-10 J96) listed as contributing causes of death were included. Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated and stratified by sex, race/ethnicity, U.S. census region, state, and urban–rural classification. Temporal trends were evaluated using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Autoregressive integrated moving average (ARIMA) models were used to forecast mortality through 2035 with diagnostic validation. Results: From 1999 to 2023, 15,035 deaths were attributed to the combined burden of brain tumors and respiratory failure. Overall AAMR increased significantly to 4.7, with an AAPC of 1.4% (95% CI: −0.0006 to 2.8; p=0.05). Forecast modeling using ARIMA (0,2,1) projected a doubling of mortality burden, with AAMR reaching 9.75 (95% CI: 3.8–15.6) by 2035 (Ljung–Box p=0.50). Men demonstrated higher mortality than women (AAMR: 5.9 vs 3.7), with rising trends observed in both sexes. Among racial groups, non-Hispanic Whites exhibited the highest burden (AAMR: 5.07). Regionally, the West demonstrated the steepest increase (AAMR: 6.6), followed by the Northeast (5.1). Large central metropolitan counties experienced the highest urban burden (AAMR: 5.04). Mississippi showed the greatest state-level mortality (AAMR: 17.1), highlighting marked geographic disparities. Conclusions: Mortality from brain tumors complicated by respiratory failure is rising nationwide and is projected to nearly double by 2035. Substantial demographic and geographic disparities persist, underscoring critical gaps in early neurologic deterioration recognition, respiratory monitoring, and ICU triage strategies. These findings emphasize the urgent need for targeted preventive interventions, optimized neurocritical care pathways, and health-system preparedness to address this rapidly expanding high-risk population.