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. 2024 Feb 2;26(2):387-396.
doi: 10.1093/neuonc/noad182.

Brain tumors in United States military veterans

John R Bihn  1 , Gino Cioffi  2   3 , Kristin A Waite  2   3 , Carol Kruchko  3 , Corey Neff  3   4 , Mackenzie Price  3   4 , Quinn T Ostrom  3   4   5 , Kaitlin N Swinnerton  1 , Danne C Elbers  1   6 , Michael A Mooney  1   7 , Jacob Rachlin  1 , Thor D Stein  1   8 , Mary T Brophy  1   8 , Nhan V Do  1   8 , Ryan E Ferguson  1   8 , David S Priemer  9   10 , Daniel P Perl  9 , Richard A Hickman  10   11   12 , Burt Nabors  13 , Jennifer Rusiecki  14 , Jill S Barnholtz-Sloan  2   3   15 , Nathanael R Fillmore  1   6
Affiliations

Brain tumors in United States military veterans

John R Bihn et al. Neuro Oncol. .

Abstract

Background: Comprehensive analysis of brain tumor incidence and survival in the Veteran population has been lacking.

Methods: Veteran data were obtained from the Veterans Health Administration (VHA) Medical Centers via VHA Corporate Data Warehouse. Brain tumor statistics on the overall US population were generated from the Central Brain Tumor Registry of the US data. Cases were individuals (≥18 years) with a primary brain tumor, diagnosed between 2004 and 2018. The average annual age-adjusted incidence rates (AAIR) and 95% confidence intervals were estimated per 100 000 population and Kaplan-Meier survival curves evaluated overall survival outcomes among Veterans.

Results: The Veteran population was primarily white (78%), male (93%), and between 60 and 64 years old (18%). Individuals with a primary brain tumor in the general US population were mainly female (59%) and between 18 and 49 years old (28%). The overall AAIR of primary brain tumors from 2004 to 2018 within the Veterans Affairs cancer registry was 11.6. Nonmalignant tumors were more common than malignant tumors (AAIR:7.19 vs 4.42). The most diagnosed tumors in Veterans were nonmalignant pituitary tumors (AAIR:2.96), nonmalignant meningioma (AAIR:2.62), and glioblastoma (AAIR:1.96). In the Veteran population, survival outcomes became worse with age and were lowest among individuals diagnosed with glioblastoma.

Conclusions: Differences between Veteran and US populations can be broadly attributed to demographic composition differences of these groups. Prior to this, there have been no reports on national-level incidence rates and survival outcomes for Veterans. These data provide vital information that can drive efforts to understand disease burden and improve outcomes for individuals with primary brain tumors.

Keywords: brain tumors; incidence; survival; veterans.

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Conflict of interest statement

The authors have no conflict of interest to declare. Jill S. Barnholtz-Sloan is a full-time paid employee of the NIH/NCI. Gino Cioffi and Kristin A. Waite are full-time contractors of the NIH/NCI.

Figures

Figure 1.
Figure 1.
Demographic characteristics of individuals with primary brain tumors in VACRS and CBTRUS by (A) age at diagnosis, (B) sex, (C) race*, and (D) ethnicity (VACRS, 2004–2018; CBTRUS: Data provided by CDC’s National Program of Cancer Registries and NCI’s Surveillance, Epidemiology and End Results Program, 2004–2018).
Figure 2.
Figure 2.
Histopathological subtype distribution of (A) all primary BT, (B) malignant brain tumors only, and (C) nonmalignant* brain tumors only, in VACRS and CBTRUS (VACRS, 2004-2018; CBTRUS: Data provided by CDC’s National Program of Cancer Registries and NCI’s Surveillance, Epidemiology and End Results Program, 2004–2018).
Figure 3.
Figure 3.
Sex distribution of histopathological subtype distribution among individuals (A) ages 18–49, (B) ages 50–69, and (C) ages 70+, in VACRS and CBTRUS (VACRS, 2004–2018; CBTRUS: Data provided by CDC’s National Program of Cancer Registries and NCI’s Surveillance, Epidemiology and End Results Program, 2004–2018).
Figure 4.
Figure 4.
Overall survival for (A) 18–49 years old, (B) 50–69 years old, and (C) 70 + years old individuals with primary malignant brain tumors in VACRS (2004–2018).
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References

    1. United States Census Bureau. https://www.census.gov/en.html.
    1. Veterans Health Administration: About VHA. Veterans Health Administration. https://www.va.gov/health/aboutvha.asp. Accessed June 1, 2023.
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    1. Department of Veteran Affairs. Environmental Health Registry Evaluations for Veterans. Washington, DC: Department of Veterans Affairs; 2023.

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