e20695 Background: Lung cancer remains the leading cause of cancer-related mortality in the United States, with a substantial proportion of deaths attributable to distant metastases, most commonly involving the brain and cerebral meninges. Central nervous system involvement signifies advanced disease and is associated with high morbidity and poor survival. Characterizing long-term national mortality trends and demographic disparities is essential for informing oncologic care and public health strategies. This study examined U.S. mortality patterns where lung cancer was the underlying cause of death (UCOD) with secondary brain and meningeal metastasis. Methods: Mortality data from 1999–2024 were obtained from the CDC WONDER database for adults aged ≥55 years. Lung cancer was identified as the UCOD using ICD-10 codes C34.0–C34.9, with secondary malignant neoplasm of the brain and cerebral meninges identified as a multiple cause of death (C79.3). Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the U.S. standard population and stratified by sex, race/ethnicity, age, state, U.S. Census region, and metropolitan status. Temporal trends were analyzed using Joinpoint regression, with statistical significance defined as p < 0.05. Results: Between 1999 and 2024, lung cancer with secondary brain and meningeal metastasis accounted for 193,506 deaths among U.S. adults aged ≥55 years. Overall mortality declined significantly, with AAMRs decreasing from 12.94 in 1999 to 9.30 in 2024 (AAPC: −1.20%). Mortality trends differed by sex; males experienced a significant decline (AAPC: −1.86%), whereas the decline among females was smaller and not statistically significant (AAPC: −0.49%). Metropolitan areas demonstrated a greater reduction in mortality (AAPC: −1.72%) compared with non-metropolitan regions, which exhibited a slower but significant decline (AAPC: −0.81%). A significant late-period increase was observed among non-Hispanic Black individuals (APC 2007–2024: +0.66%). Regionally, the Northeast experienced the most pronounced overall decline (AAPC: −2.19%). Conclusions: Over a 25-year period, lung cancer related mortality with secondary brain and meningeal metastases demonstrated an overall declining trend, despite a notable mid-period increase between 2013 and 2017 followed by a subsequent plateau. Despite overall improvements, mortality remained disproportionately higher among males, non-Hispanic White and Black populations, and residents of non-metropolitan regions. These findings highlight the persistent lethality and unequal burden of advanced lung cancer with CNS involvement, underscoring the need for earlier detection, improved CNS-directed therapies, and geographically targeted interventions to further reduce mortality.
Ahmed et al. (Thu,) studied this question.