BACKGROUND:Molecular profiling has become an integral part of glioma classification. The extent to which incidence of molecularly-defined adult-type gliomas vary by demographics is unknown. We describe national-level incidence and overall survival patterns of selected glioma subtypes by race/ethnicity. METHODS:We generated standardized average annual age-adjusted incidence rates of molecularly-defined glioma subtypes by race/ethnicity from the Central Brain Tumor Registry of the United States (CBTRUS) using newly-diagnosed cases from January 1, 2018 to December 31, 2022. Survival data from the National Cancer Database (NCDB) were used from newly-diagnosed cases from January 1, 2018 to December 31, 2021 (with follow up through December 31, 2022) to evaluate four-year overall survival, median survival, and multivariable Cox Proportional hazards ratios. RESULTS:CBTRUS identified 68,172 glioma cases, IDH-wildtype glioblastoma was most common (n = 51,548). Non-Hispanic White individuals had significantly higher incidence of all gliomas compared to other groups (p > 0.001). Non-Hispanic Black individuals had the lowest incidence for IDH-mutant astrocytoma and oligodendroglioma, and shared lowest incidence of IDH-mutant glioblastoma and IDH-wildtype astrocytoma with non-Hispanic other individuals, who had the lowest incidence of IDH-wildtype glioblastoma (p < 0.001). The odds of having an IDH-wildtype (versus IDH-mutant) astrocytoma or glioblastoma were significantly lower for males, those of older age, and non-Hispanic Black individuals (p < 0.001). Non-Hispanic other individuals also had increased adjusted overall survival for most glioma subtypes compared to other racial/ethnic groups (p < 0.001). Four-year overall survival was lowest in all racial/ethnic groups for IDH-wildtype glioblastoma (p < 0.001). CONCLUSIONS:Our findings reveal significant disparities in incidence and survival by race/ethnicity with notable variations present based on glioma biomarkers.

Abstract Background The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), is the largest aggregation of histopathology-specific, population-based data for primary brain and other central nervous system tumors (BTs) in the United States. Summarized are the key findings from the 2025 CBTRUS annual statistical report and additional clinically relevant statistics for neuro-oncology healthcare providers. Methods CBTRUS incidence data are an aggregation of 48 central cancer registries (CCRs) from the CDC’s National Program of Cancer Registries (NPCR) and 4 CCRs from the NCI’s Surveillance, Epidemiology, and End Results Program covering the entire US population. Puerto Rico was excluded. Survival data were obtained from 43 NPCR CCRs. Mortality data were obtained from the National Vital Statistics System. All incidence and mortality rates were age-adjusted using the 2000 US standard population. Relative survival was estimated using the life table method. Overall survival was estimated using Kaplan–Meier models. Results The average annual age-adjusted incidence rate of all BTs was 26.05 per 100 000 population. Incidence was higher among females and non-Hispanic Black individuals. The most common malignant tumors were gliomas. The most common non-malignant tumors were low-grade meningiomas. Mortality rates and median survival varied by age, sex, and tumor type. Conclusions This summary describes the most up-to-date population-based incidence, mortality, and survival of primary BT types in the United States with an age-focused analysis and aims to serve as a concise resource for neuro-oncology healthcare providers.

Abstract Background Glioma is a heterogeneous group of tumors that make up the most common type of primary malignant brain tumor. Incidence varies globally, with highest rates in Europe and North America and lowest in Asia and Africa. Within the United States, these tumors are most common in individuals who are non-Hispanic White. Previously, genome-wide association studies (GWAS) have identified 25 single nucleotide polymorphisms (SNPs) which affect risk for glioma (European only), most of which have subtype-specific differences. SNP allele frequencies (AF) vary between continental populations. We estimated population-level incidence for adult-type diffuse glioma subtypes and calculated the difference between observed variation and variation attributable to AF differences. Methods Race/ethnicity-stratified age-adjusted incidence rates for glioma subtypes (Astrocytoma with IDH1/2 mutation [IDHmut], Astrocytoma with wildtype IDH1/2 [IDHwt], and Oligodendroglioma with IDH1/2 mutation and 1p/19q codeletion [IDHmut-codel]) from diagnosis years 2018-2022 were calculated using the Central Brain Tumor Registry of the United States, an aggregation of CDC’s National Program of Cancer Registries and NCI’s SEER. Incidence rate ratios (IRRO) were estimated as compared to non-Hispanic White. Effect estimates for known glioma risk SNPs were extracted from a prior subtype-specific glioma GWAS (Labreche, 2018) for SNPs with p<4x10-4. AF were extracted from the Allele Frequency Aggregator for the European and African American populations. We calculated the normalized IRR (IRRN) for each SNP based on population AF and summed these to estimate the incidence variation attributable to AF. IRRN was calculated by multiplying the beta by the corresponding AF. Results As compared to individuals who are non-Hispanic White, incidence was decreased in non-Hispanic Black individuals for all subtypes [IDHmut IRRO=0.40, IDHwt IRRO=0.49, IDHmut-codel IRRO=0.29]. IRRN were attenuated as compared to observed rates [IDH-mut IRRN=0.78, IDH-wt IRRN=0.75, IDHmut-codel IRRN=0.64]. The IRRN is higher compared to the IRRO, with the greatest differences being observed in the non-Hispanic Black population. Conclusion IRRN fail to fully explain population differences in incidence of glioma. This may be a result of limited ancestral diversity in GWAS, which have not assessed SNPs in individuals who are African American. Sample sizes for subtype-specific GWAS have been small and underpowered. These SNPs do not capture all genetic risk for glioma (all identified SNPs explain 30% of heritable risk), and there is significant ‘missing heritability.’ These results emphasize the need for inclusion of more diverse populations in glioma genetic epidemiology to ensure accurate genetic risk estimation. Citation Format: Christine Ann Pittman Ballard, Carol Kruchko, Mackenzie Price, Quinn T. Ostrom. Allele frequency variation in people of European and admixed African ancestry in the United States do not fully explain incidence differences in adult-type diffuse glioma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 5061.

Purpose:Vestibular schwannoma (VS) is a benign tumor of the eighth cranial nerve with incidence that differs by age, sex, and race/ethnicity. Prior research has not characterized how the contributions of sex and race/ethnicity to VS risk may interact or vary by age. We sought to examine the joint contributions of age, sex, and race/ethnicity to VS risk using nationally-representative data. Methods:Diagnoses of non-malignant, intracranial VS were extracted from the Central Brain Tumor Registry of the United States (CBTRUS, 2004-2020) and used to calculate average age-adjusted annual incidence rates (AAAIRs) and incidence rate ratios (IRRs). Poisson regression was used to evaluate associations of VS risk with sex, race/ethnicity, and their interaction (sex*race/ethnicity), both overall and in ten-year intervals of age. Results:Over an eighteen-year period, 78002 unique individuals received a new diagnosis of VS (52.9% female). Females were at elevated risk compared to males from ages 10-59, after which this trend inverted with males at increased risk. Compared to non-Hispanic White individuals, Hispanic and non-Hispanic Black individuals were at significantly reduced risk of VS throughout the lifespan. The protective effect of non-Hispanic Black race/ethnicity was apparent among both females (IRR=0.40; 95% CI: 0.38-0.42) and males (IRR=0.36; 95% CI: 0.34-0.38), but was significantly stronger among males (Pinteraction<0.001). Conclusions:Age significantly modifies the relationship between sex and risk of VS, while sex significantly modifies the relationship between race/ethnicity and risk of VS. Findings underscore the importance of incorporating demographic data into studies of VS biology, diagnosis, and clinical management.

BACKGROUND:US incidence rates of nonmalignant brain tumors are 3-fold higher in highest versus lowest incidence states. A county-level analysis was conducted to assess whether geographic variation in nonmalignant meningioma (NMM) incidence is related to demographics, cancer registry, health care, and other factors. METHODS:Age-adjusted incidence rates of NMM in US counties during 2010-2019 were modeled with data from the Central Brain Tumor Registry of the United States. Demographic, geographic, cancer registry, environmental, health care, health, lifestyle, and socioeconomic factors at the county level were drawn from numerous data sources. Bayesian index regression models were fit containing spatial random effects. RESULTS:Three domains were significantly associated with rates of NMM at the county level: cancer registry practices (funding source and % radiographically confirmed), socioeconomic status index (higher levels with percent working in white-collar occupations as an important contributor), and demographics (% Black and % female). No associations were observed for general health or environmental factors. In the fully adjusted model, the number of counties with significantly elevated and lowered spatial random effects decreased by 33% and 28%, respectively, compared to a no-covariate model. CONCLUSIONS:Although general health and environmental factors cannot be ruled out in explaining the geographic variation in NMM incidence rates, results suggest that socioeconomic factors, certain demographic characteristics, and cancer diagnosis and registry practices may all play a significant role in driving such variation. These results may have implications for other tumor types diagnosed primarily radiographically or outside hospital settings, where variation in detection and reporting may affect incidence rates.

The Central Brain Tumor Registry of the United States (CBTRUS), an aggregation of data from the Centers for Disease Control and Prevention's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology and End Results program, is the largest population-based registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States (US). As of this report, the CBTRUS database represents the entire US population. This report contains the most up-to-date population-based data on primary brain tumors and supersedes all previous reports in terms of completeness and accuracy. All rates are age-adjusted using the 2000 US standard population and presented per 100,000 population. Between 2018 and 2022, the average annual age-adjusted incidence rate (AAAIR) of all primary malignant and non-malignant brain and other CNS tumors was 26.05 per 100,000 population (malignant AAAIR=6.86 and non-malignant AAAIR=19.19). Incidence was higher in women compared to men (29.67 versus 22.23 per 100,000) and in non-Hispanic Black individuals compared to non-Hispanic White (27.40 versus 26.36 per 100,000), non-Hispanic American Indian/Alaska Native (24.38 per 100,000), non-Hispanic Asian or Pacific Islander (20.42 per 100,000), and Hispanic individuals of all races (24.69 per 100,000). Gliomas accounted for 22.2% of all tumors. The most commonly occurring malignant brain and other CNS histopathology was glioblastoma (13.7% of all tumors and 52.2% of all malignant tumors), and the most common non-malignant histopathology was meningioma (42.6% of all tumors [includes malignant meningioma] and 57.4% of all non-malignant tumors). Glioblastoma was more common in men, and meningioma was more common in women. In children and adolescents (ages 0-19 years), the incidence rate of all primary brain and other CNS tumors was 5.99 per 100,000 population. Overall, there were 88,186 total deaths attributed to malignant brain and other CNS tumors between 2018 and 2022, representing an average of 17,637 deaths per year and an average annual mortality rate of 4.41 per 100,000 population. The five-year relative survival rate following diagnosis of a malignant brain or other CNS tumor was 34.8%, while it was 91.7% for a non-malignant brain or other CNS tumor.

BACKGROUND:Years of life lost (YLL) is a disease burden measure quantifying the number of years lost due to premature mortality for a given disease. The present study sought to assess YLL for primary brain and other central nervous system (CNS) tumor histopathologies in the United States. METHODS:Mortality, incidence, and life expectancy data for mortalities occurring in 2018 were obtained from the National Vital Statistics System and the National Program of Cancer Registries. Tumor-specific YLL were estimated by subtracting age of death from projected life expectancy; mean YLL (mYLL) was determined to assess the impact of CNS tumor diagnosis on the individual patient level. RESULTS:For mortalities occurring in 2018, the total YLL due to malignant CNS tumors was 364 223 years (mYLL = 21.2 years), compared to 15 472 years (mYLL = 14.2 years) for nonmalignant tumors. Glioblastoma had the highest total YLL among malignant CNS tumors (58.8% of all primary CNS tumor YLL; mYLL = 19.8 years), and nonmalignant meningioma among nonmalignant CNS tumors (2.9% of all primary CNS tumor YLL; mYLL = 14.4 years). Malignant pediatric tumors had the greatest mYLL, with medulloblastoma having a mYLL of 61.2 years and other embryonal tumors having an mYLL of 50.7. CONCLUSIONS:Malignant CNS tumors, glioblastoma in particular, contributed the most to total YLL, whereas pediatric CNS malignancies had the greatest mYLL. Used with other epidemiological data, the authors contend that this quantification may help rationalize the allocation of clinical and research resources.

Brain and other central nervous system (CNS) tumors are a significant source of global morbidity and mortality. Despite decades of epidemiological research, there are few known risk factors for these tumors. Incidence of brain tumors varies significantly by country region of the world, and by sex, ethnicity, and age within countries. The aim of this study was to generate up-to-date estimates of glioma incidence rates by global region with the aim of providing a framework for international risk factor research. Using data from the International Agency for Research on Cancer’s Cancer Incidence in Five Continents-XII (new diagnoses from 2013-2017 from 460 cancer registries across 65 countries) and the Central Brain Tumor Registry of the United States from 2013-2017 (~99% of new US diagnoses) we calculated the incidence rates per 100,000 person-years and 95% confidence intervals age-adjusted to the world standard population (AAIR). Incidence was estimated for glioma, astrocytoma, and oligodendroglioma by age group, sex, site, and histology. Countries were grouped based on World Bank regional definitions. Glioma incidence varied significantly by region. The highest rates of glioma were seen in the Oceania (AAIR=5.23, 95%CI=5.13-5.33), and Northern Europe (AAIR=5.06, 95%CI=5.00-5.12). Lowest incidence was reported in Southeast Asia (AAIR=0.96, 95%CI=0.90-1.02) and Sub-Saharan Africa (AAIR=1.05, 95%CI=0.94-1.18). Astrocytic tumors and Oligodendroglioma were highest in Oceania (AAIR = 4.01, 95% CI=3.93-4.10, AAIR = 0.54, 95% CI =0.51-0.58, respectfully) and lowest in Southeast Asia (AAIR = 0.66, 95% CI=0.61-0.71, AAIR = 0.08, 95% CI=0.06-0.12, respectfully). There continues to be significant global variation in the incidence of glioma despite improvements in data collection and imaging technology. While inequitable access to health care resources may exacerbate these differences, assessment of regional differences may provide evidence for future risk factor study and provide information for planning of global research initiatives.

Abstract Background The most common childhood central nervous system cancer in the United States (US) is pediatric low-grade glioma (pLGG). However, pLGG is not readily identified in cancer registry data because there is no standardized set of International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) codes to define pLGG. Identification of these patients is essential to understanding this disease. Methods The objectives of this retrospective study are to: 1) identify ICD-O-3 codes for a pLGG as a definition template, and 2) describe the pLGG incidence in the US using 2015-2019 data from the CBTRUS, an aggregation of data from the CDC’s National Program of Cancer Registries and NCI’S Surveillance, Epidemiology, and End Results program. These years were selected to obtain the latest data without the potential impacts of COVID-19. To define pLGG, ICD-O-3 codes were identified based on comprehensive literature reviews. Average annual pLGG incidence was calculated in US patients aged 0-18 years overall, by grade and by ICD-O-3 code. Grade was defined by Collaborative Staging Site-Specific Factor 1: WHO Grade (2015-2017 diagnoses) and by Grade – Pathological (2018-2019 diagnoses). Results Eighteen ICD-O-3 codes defined pLGG in this study. Between 2015 and 2019, average annual new cases of pLGG for those aged 0-18 years was 1,934. Among all patients diagnosed in 2015-2019, 40.7% had an unknown tumor grade (N = 787). The most frequent diagnosis was pilocytic astrocytoma, malignant (ICD O-3 code 9421/3). The annual average incidence for pilocytic astrocytoma was 731, which comprised 37.8% of pLGG in 2015-2019. Discussion and Conclusions Identification of patient populations with pLGG is complex. Unknown tumor grade comprises a substantial proportion of patients; therefore, selection of those classified as low-grade underestimates pLGG incidence. This study provides a comprehensive definition of pLGG to fill the current research gaps and accurately describes pLGG incidence in the US.

BACKGROUND:Glioblastoma (GBM) is the most common malignant primary central nervous system (CNS) tumor, accounting for half (50.9 %) of all malignant tumors diagnosed in the US. We conducted a population-based analysis using Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR) survival database investigate which patient- and tumor-level factors are characteristic of long-term survivors (LTS) of GBM. METHODS:Individual-level survival data containing diagnoses of primary GBM were obtained from the NPCR survival database for cases diagnosed during the period of January 1st, 2010 to December 31st, 2016, and followed through December 31st, 2019. Differences in LTS (>36-months) were investigated using χ2 tests and multivariable logistic regression. Frequency of IDHmut-GBM by age was estimated in the same dataset from 2018 to 2021. RESULTS:Of the included GBM, 11.6 % met criteria for LTS. After adjustment for known prognostic factors, males (OR=0.78, p < 0.001) and age > 60 at diagnosis, were all significantly associated with decreased odds of LTS (70-79 years O =0.48, 80 + years OR=0.21, both p < 0.001). Frequency of IDHmut-GBM peaked from 25 to 34, with < 5 % of GBM in those > 50 having IDHmut-GBM. In a sensitivity analysis in those > 50 diagnosis, both male sex and age remained significant predictors of LTS CONCLUSION: There are multiple patient- and tumor-level factors that are associated with improved survival in GBM, with the strongest effect sizes in the multivariable models being due to age. These results demonstrate substantial heterogeneity in GBM prognosis and emphasize the distinct survival advantage associated with age at diagnosis.

Abstract Background Atypical teratoid/rhabdoid tumor (ATRT) is a rare malignant brain tumor that affects children ≤3 years and is associated with significant mortality. ATRT was established as a unique entity in 2001 and is diagnosed by specific molecular and methylation features. In this analysis, we present the most up-to-date descriptive epidemiology of ATRT in children and adolescents. Methods The Central Brain Tumor Registry of the United States, a combined dataset of the CDC’s National Program of Cancer Registries (NPCR) and NCI’s Surveillance, Epidemiology, and End Results Program, was used to estimate average annual age-adjusted incidence rates (AAAIR) and 95% confidence intervals (95%CI) per 100,000 population for ATRT diagnosed between 2005-2021 in those 0-19 years at diagnosis. AAAIR were calculated overall and by age group at diagnosis, sex, race/ethnicity, and tumor site (supratentorial, infratentorial, spine and cauda equina, and other brain/CNS). Relative survival rates (RS) from 2005-2020 using the CDC’s NPCR survival dataset by age group, sex, race/ethnicity, tumor site, and treatment (surgery and radiation, surgery only, or other/unknown). Results There were 1,240 new cases of ATRT diagnosed from 2005-2021 (AAAIR=0.09/100,000, 95%CI=0.08-0.09). Incidence did not significantly vary by sex and was lowest among non-Hispanic Black individuals. AAAIR was highest in children <1 year, with decreasing incidence with increasing age. Among those <1 year, infratentorial tumors had the highest incidence (AAAIR=0.26/100,000, 95%CI=0.22-0.30). Overall, 1- and 10-year RS were 58.7% and 33.5%, respectively. RS was highest among those who were 4-19 years, non-Hispanic White, with supratentorial tumor location, and who received surgery and radiation. Conclusion ATRT is associated with some of the poorest outcomes among rare pediatric CNS tumors. Survival varies significantly by race/ethnicity, treatment pattern, and tumor location. Understanding populations most affected and differences related to ATRT subgroups is necessary for furthering etiologic and clinical research.

This report comprehensively describes the most up-to-date incidence of primary brain and other central nervous system (CNS) tumors in children and adolescents (ages 0-19 years old), utilizing population-based data collected and reported by central cancer registries covering 99.9% of the United States population. Overall, brain and other CNS tumors are the most common cancer and the most common cause of cancer death in children and adolescents. This report aims to serve as a resource for researchers, clinicians, patients, and families.

The Brain Tumor Epidemiology Consortium (BTEC) is an international organization with membership of individuals from the scientific community with interests related to brain tumor epidemiology, including surveillance, classification, methodology, etiology, and factors associated with morbidity and survival. The 2024 annual BTEC meeting entitled "Survivorship from Pediatric and Adult Brain Tumors" was held in Mainz, Germany, USA, on May 15-17, 2024. The meeting gathered scientists from Africa, Australia, Europe, and North America and included 4 keynote sessions focusing on brain tumor survivorship across the age spectrum. The meeting included 3 abstract sessions, which also included scientific talks around brain tumor risk factors and predicting risk and survival. We also held a brainstorming session to form a near-term research strategy around brain tumor survivorship in the epidemiology community. This report provides a summary of the meeting content.

The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control and Prevention (CDC) and National Cancer Institute (NCI), is the largest aggregation of histopathology-specific population-based data for primary brain and other central nervous system (CNS) in the US. CBTRUS publishes an annual statistical report which provides critical reference data for the broad neuro-oncology community. Here, we summarize the key findings from the 2022 CBTRUS annual statistical report for healthcare providers.Incidence data were obtained from the CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology, and End Results Program for 52 central cancer registries (CCRs). Survival data were obtained from 42 NPCR CCRs. All rates are per 100 000 and age-adjusted using the 2000 US standard population. Overall median survival was estimated using Kaplan-Meier models. Survival data for selected molecularly defined histopathologies are from the National Cancer Database. Mortality data are from the National Vital Statistics System.The average annual age-adjusted incidence rate of all primary brain and other CNS tumors was 24.25/100 000. Incidence was higher in females and non-Hispanics. The most commonly occurring malignant and predominately non-malignant tumors was glioblastoma (14% of all primary brain tumors) and meningioma (39% of all primary brain tumors), respectively. Mortality rates and overall median survival varied by age, sex, and histopathology.This summary describes the most up-to-date population-based incidence, mortality, and survival, of primary brain and other CNS tumors in the US and aims to serve as a concise resource for neuro-oncology providers.

BACKGROUND:Non-malignant primary tumors of the spine (NMPTS) patients in rural areas face unique barriers that may limit their capacity to receive optimal care. With a lower geographical distribution of neurosurgical specialists and limited healthcare infrastructure, rural NMPTS patients may receive certain treatments at a lower frequency than metropolitan patients. NMPTS We sought to examine the association between residential urbanicity, race-ethnicity, treatment patterns, and survival outcomes for cases diagnosed with NMPTS. METHODS:Cases of NMPTS diagnosed between 2004 and 2019 were identified from the Central Brain Tumor Registry of the United States (CBTRUS), a combined dataset of CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology and End Results (SEER) data. Using multivariable logistic regression, we evaluated the association between urbanicity and treatment (including surgery and radiation), adjusted for age at diagnosis, sex, and race-ethnicity. Patient-level all-cause survival data were obtained from the NPCR Survival Analytical Database (2004-2018). RESULTS:A total of 38,414 cases were identified, 33,097 of whom lived in metropolitan and 5317 of whom lived in non-metropolitan regions. Nerve sheath tumors and meningiomas were the most common tumor histopathologies across both regions, with no clinically significant difference in other histopathologies (p<0.001). There were statistically significant differences between the frequency and type of surgery received by urbanicity (p<0.001). Overall all-cause survival was significantly lower for NH Blacks residing in non-metropolitan areas when compared to NH Blacks residing in metropolitan areas (p<0.0001). CONCLUSION:Our data demonstrates significant differences in the incidence of NMPTS across both race-ethnicity and urbanicity. However, a wider analysis of all-cause mortality reveals disparities in health outcomes across both race-ethnicity and urbanicity for Black and Hispanic populations. To address the disparity in health outcomes, policymakers and health providers need to work with local communities in rural areas to improve access to equitable and quality healthcare.

INTRODUCTION: Prior literature suggests that individual socioeconomic status (SES) may influence access to treatment and outcomes for primary brain tumors. To date, no population-level studies have assessed the correlation between meningioma treatment and outcome with county-level SES. METHODS: Incidence data were extracted from the Central Brain Tumor Registry of the United States(CBTRUS), a combined dataset including the CDC’s National Program of Cancer Registries (NPCR) and NCI’s Surveillance, Epidemiology, and End Results Program data, for diagnosis years 2006-2019, and survival data were extracted from the NPCR survival analytic dataset from 2006-2018. SES quintiles were created using American Community Survey data. Logistic regression and Cox proportional hazards models were used to assess the relationship the odds of receiving treatment and overall survival and SES and the individual SES factors. RESULTS: There were 409,681 meningioma cases available from CBTRUS. Asian/Pacific-Islander non-Hispanic individuals (odds ratio [OR] = 1.28, p < 0.001) were more likely and Black non-Hispanic (BNH) individuals (OR = 0.90, p < 0.001) were less likely to receive surgery than White non-Hispanic (WNH) individuals. Female sex (OR = 1.31, p < 0.001), living in a metropolitan area (OR = 0.96, p < 0.001), and increased age at diagnosis (OR = 0.96, p < 0.001) were associated with decreased likelihood of surgery. There was no association between SES and likelihood to receive surgery. Overall median survival was 137 months and survival was higher in higher SES counties, which held true for both WNH and BNH. Age at diagnosis(hazard ratio [HR] = 1.01, p < 0.001), male sex (HR = 1.51, p < 0.001), BNH (HR = 1.31, p < 0.001), subtotal resection (HR = 1.38, p < 0.001), and malignant behavior(HR = 1.64, p < 0.001) were associated with increased hazard of death. CONCLUSIONS: In the US, county-level SES did not impact treatment patterns, but higher SES was associated with increased survival. These findings provide valuable insight into socioeconomic factors influencing treatment and outcomes in meningioma patients.

BACKGROUND: Spinal cord ependymomas (SCEs) represent the most common intramedullary spinal cord tumors among adults. Research shows that access to neurosurgical care and patient outcomes can be greatly influenced by patient location. This study investigates the association between the outcomes of patients with SCE in metropolitan and nonmetropolitan areas. METHODS: Cases of SCE between 2004 and 2019 were identified within the Central Brain Tumor Registry of the United States, a combined dataset including the Centers for Disease Control and Prevention's National Program of Cancer Registries and National Cancer Institute's Surveillance, Epidemiology, and End Results Program data. Multivariable logistic regression models were constructed to evaluate the association between urbanicity and SCE treatment, adjusted for age at diagnosis, sex, race and ethnicity. Survival data was available from 42 National Program of Cancer Registries (excluding Kansas and Minnesota, for which county data are unavailable), and Cox proportional hazard models were used to understand the effect of surgical treatment, county urbanicity, age at diagnosis, and the interaction effect between age at diagnosis and surgery, on the survival time of patients. RESULTS: Overall, 7577 patients were identified, with 6454 (85%) residing in metropolitan and 1223 (15%) in nonmetropolitan counties. Metropolitan and nonmetropolitan counties had different age, sex, and race/ethnicity compositions; however, demographics were not associated with differences in the type of surgery received when stratified by urbanicity. Irrespective of metropolitan status, individuals who were American Indian/Alaska Native nonHispanic and Hispanic (all races) were associated with reduced odds of receiving surgery. Individuals who were Black non-Hispanic and Hispanic were associated with increased odds of receiving comprehensive treatment. Diagnosis of SCE at later ages was linked with elevated mortality (hazard ratio = 4.85, P < 0.001). Gross total resection was associated with reduced risk of death (hazard ratio = 0.37, P = 0.004), and age did not interact with gross total resection to influence risk of death. CONCLUSIONS: The relationship between patients' residential location and access to neurosurgical care is critical to ensuring equitable distribution of care. This study represents an important step in delineating areas of existing disparities.

BACKGROUND:To mitigate disease spread, restrictions implemented in the United States surrounding the COVID-19 pandemic created an environment that led to delays in cancer diagnosis. The data needed to accurately analyze the impact of the pandemic on brain and CNS tumor incidence has not been available until now. Utilizing incidence data from the Central Brain Tumor Registry of the United States (CBTRUS) we analyzed the impact of the COVID-19 pandemic on primary brain and other CNS tumor incidence for the first year of the pandemic.METHODS:Monthly age-adjusted incidence rates and incidence trends for 2019 and 2020 were determined for age at diagnosis, sex, race, ethnicity, diagnostic confirmation, behavior, tumor histopathology, and county-level urbanization. Monthly incidence rate ratios comparing 2020 and 2019 were evaluated for the same factors.RESULTS:Overall, there was a notable decrease in incidence rates in March-May 2020 when compared to 2019. These decreases were driven by nonmalignant tumors, with a 50% incidence decrease between March 2020 and 2019. Individuals who were Black had a larger incidence decrease in early 2020 than individuals who were White. Radiographically confirmed tumors saw larger incidence decreases than histologically confirmed tumors. There were no changes in monthly incidence of glioblastoma in 2020 compared to 2019.CONCLUSIONS:These data provide evidence that disruptions in medical care, such as governmental and health care mandates, in response to the COVID-19 pandemic resulted in an overall decreased incidence of primary brain tumors in early 2020.

Background:Meningioma risk factors include older age, female sex, and African-American race. There are limited data exploring how meningioma risk in African-Americans varies across the lifespan, interacts with sex, and differs by tumor grade. Methods:The Central Brain Tumor Registry of the United States (CBTRUS) is a population-based registry covering the entire U.S. population. Meningioma diagnoses from 2004-2019 were used to calculate incidence rate ratios (IRRs) for non-Hispanic Black individuals (NHB) compared to non-Hispanic white individuals (NHW) across 10-year age intervals, and stratified by sex and by WHO tumor grade. Results:53,890 NHB individuals and 322,373 NHW individuals with an intracranial meningioma diagnosis were included in analyses. Beginning in young adulthood, the NHB-to-NHW IRR was elevated for both grade 1 and grade 2/3 tumors. The IRR peaked in the seventh decade of life regardless of grade, and was higher for grade 2/3 tumors (IRR=1.57; 95% CI: 1.46-1.69) than grade 1 tumors (IRR=1.27; 95% CI: 1.25-1.30) in this age group. The NHB-to-NHW IRR was elevated in females (IRR=1.17; 95% CI: 1.16-1.18) and further elevated in males (IRR=1.28; 95% CI: 1.26-1.30), revealing synergistic interaction between NHB race/ethnicity and male sex (P Interaction =0.001). Conclusions:Relative to NHW individuals, NHB individuals are at elevated risk of meningioma from young adulthood through old age. NHB race/ethnicity conferred higher risk of meningioma among men than women, and higher risk of developing WHO grade 2/3 tumors. Results identify meningioma as a significant source of racial disparities in neuro-oncology and may help to improve preoperative predictions of meningioma grade.