Trends in Mortality Related to Lung Cancer and Secondary Brain Metastasis Among Older Adults in the United States From 1999 to 2020; Insights From CDC-WONDER.

[INTRODUCTION] Lung cancer (LC) is a major cause of secondary brain metastasis (SBM); however, mortality patterns associated with these conditions among older adults in the United States remain understudied. This study aimed to investigate trends in age-adjusted mortality rates (AAMRs) and identify demographic and geographical disparities from 1999 to 2020.

[METHODS] This retrospective cross-sectional analysis used death certificate data from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, spanning 1999-2020. The study focused on older adults (≥ 65 years), identifying cases where LC and SBM were recorded as either the underlying or contributing causes of death. AAMRs per 100,000 people, and annual percent changes (APCs) were calculated. Trends were analyzed by year, sex, race/ethnicity, and geographical region.

[RESULTS] The overall AAMR dropped between 1999 and 2013, increased steadily until 2017 (APC:3.4; 95% CI: -1.25 to 5.4), and then stabilized until 2020. Men had higher AAMRs (14.3) compared to women (10.0). Among racial/ethnic groups, non-Hispanic (NH) Whites (12.7) and NH Blacks (11.7) had the highest AAMRs. Most patients died at home (44.5%). Geographically, the Midwest (13.0) and rural areas (11.4) showed higher mortality, highlighting notable disparities. States with LC- and SBM-related mortality rates in the 90th percentile included Arkansas, Mississippi, Vermont, Indiana, and West Virginia.

[CONCLUSION] Following an initial decline, mortality has risen again in recent years. Considerable disparities were noted among various demographics and regions. Equitable efforts, including early diagnosis and management, are essential to reduce the burden on high-risk populations.