Mortality patterns and disparities in primary malignant brain neoplasms among U.S. adults aged ≥75 years: A 25-year retrospective analysis.

e14064 Background: Primary malignant neoplasms of the brain disproportionately affect older adults, yet population-level mortality patterns among individuals aged ≥75 years remain insufficiently characterized. This study aims to evaluate temporal trends and demographic disparities in mortality due to primary malignant brain neoplasms among U.S. adults aged ≥75 years. Methods: Mortality data were obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death database for adults aged ≥75 years. Primary malignant brain neoplasms were identified using ICD-10 code (C71), and age-adjusted mortality rates (AAMR) were calculated per 100,000 population. Temporal trends were evaluated using Joinpoint regression to estimate average annual percent change (AAPC) with 95% confidence intervals. Results: Between 1999 and 2023, brain neoplasms among adults ≥75 years led to 101,761 deaths, with the most deaths being recorded at the decedent's home (49.28%). The AAMR rose from 19.9 in 1999 to 22.3 in 2023 with an associated AAPC of 0.59 (p < 0.000001). In 1999, men had an AAMR of 24.9, while women had an AAMR of 16.88. In 2023 men had an AAMR of 27.20, while women had an AAMR of 18.65 (AAPC: 0.53; p < 0.000001 and AAPC: 0.46; p = 0.000038 for men and women respectively). Non-Hispanic White individuals had an AAMR of 24.19 (AAPC: 0.74; p < 0.000001) in 2023, which was almost twice as high as the AAMR of Non-Hispanic Black individuals, who experienced an AAMR of 12.12 in 2023 (AAPC: 0.52; p < 0.027657). This was followed by Hispanic or Latino individuals with an AAMR of 11.57 in 2023 (AAPC:1.26; p = 0.000483). States with the highest AAMRs included South Dakota (27.38). Arkansas (24.97) and Nebraska (24.89); states with the lowest AAMRs included Hawaii (10.65), District of Columbia (12.62) and New York (18.04). Geographically, the South had the highest AAMR of 23.08 in 2023 (AAPC: 0.48; p=0.000046), while the Northeast had the lowest AAMR of 19.99 in 2023 (AAPC: 0.81; p=0.000049). Conclusions: Mortality due to primary malignant brain neoplasms among U.S. adults aged ≥75 years has shown a sustained and statistically significant increase from 1999 to 2023, underscoring a growing public health burden in this rapidly expanding age group. Persistent disparities by sex, race/ethnicity, geography, and state highlight inequities in risk, access to care, and outcomes. Targeted strategies focusing on early recognition, equitable access to specialized neuro-oncologic care, and region-specific interventions are essential to address the rising mortality and demographic disparities. Metric Findings Deaths 101,761; 49% home AAMR 19.9→22.3; AAPC 0.59 Disparities Men, Non-Hispanic White highest Region South highest; Northeast lowest States South Dakota, Arkansas, Nebraska had the highest burden