Trends and disparities in mortality due to secondary malignant neoplasm of the brain and cerebral meninges in the United States (1999-2024).

introductionSecondary malignant neoplasms of the brain and cerebral meninges are among the most common intracranial malignancies in adults and a major contributor to cancer-related death. Despite substantial therapeutic advances, national mortality trends and the disparities within them have not previously been characterized.

methodsWe obtained mortality data for U.S. adults aged 25 years and older from the CDC WONDER Multiple Cause of Death database for 1999 through 2024. Deaths were identified using ICD-10 code C79.3 (secondary malignant neoplasm of brain and cerebral meninges) recorded as a multiple cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated overall and by sex, age group, race and ethnicity, census region, state, urbanization level, and place of death. Temporal trends were assessed by Joinpoint regression, yielding annual and average annual percent changes (APCs and AAPCs) with 95% confidence intervals (CIs). A sensitivity analysis restricted to the 4.3% of deaths in which C79.3 was the underlying cause was performed.

resultsA total of 447,724 deaths were recorded, most occurring at the decedent's home (42.85%). The overall AAMR declined from 9.65 in 1999 to 8.01 in 2024 (AAPC - 0.69; 95% CI - 1.23 to - 0.16; p = 0.012). Rates fell steeply through 2007 (APC - 4.41; p < 0.001), changed little to 2013 (APC - 0.71; 95% CI - 1.75 to 0.35), rose non-significantly to 2016 (APC 4.11; 95% CI - 0.07 to 8.46), and then increased significantly through 2024 (APC 1.36; 95% CI 0.94 to 1.78). Adults aged 65 years and older had the highest average AAMR and adults aged 25-44 years the lowest (23.27 vs. 0.85). Mortality was higher in males than females (8.13 vs. 7.20). The Midwest had the highest average AAMR and the Northeast the lowest (8.13 vs. 6.42). Non-Hispanic (NH) White individuals had the highest average AAMR and Hispanic or Latino individuals the lowest (8.10 vs. 4.26). Non-metropolitan areas exceeded metropolitan areas (9.12 vs. 7.12; 1999-2020). Arkansas had the highest state-level AAMR in both periods (14.79 in 1999-2020; 14.90 in 2021-2024).

conclusionMortality from secondary malignant neoplasm of the brain and cerebral meninges fell substantially in the first decade of the study period but has risen since the mid-2010s, a reversal evident across sexes, most age groups, and most regions. The burden remains concentrated among older adults, males, NH White individuals, and non-metropolitan populations. Because brain metastasis is a complication of systemic cancer rather than a directly preventable condition, these findings argue for improved control of the primary malignancies alongside timely neuro-oncologic diagnosis and equitable access to specialized care. CLINICAL TRIAL NUMBER: Not applicable.