Burden of Central Nervous System Cancer in the United States, 1990-2021

GBD 2021 US CNS Cancer Collaborators; Hyun Jin Han¹, Yun Seo Kim², Seoyeon Park³, Jae Il Shin⁴, Min Seo Kim^{5

6}, Ju Hyung Moon⁷, Yong Bae Kim¹, Hazim S Ababneh⁸, Ahmed Abu-Zaid^{9

10}, Demelash Areda^{11

12}, Santhosh Arul¹³, Ahmed Y Azzam^{14

15}, Mainak Bardhan¹⁶, Mohammad Amin Bayat Tork¹⁷, Babak Behnam^{18

19}, Gokce Belge Bilgin²⁰, Prarthna V Bhardwaj²¹, Soumitra S Bhuyan²², Nima Broomand Lomer²³, Meng Xuan Chen²⁴, Suma Sri Chennapragada²⁵, Xiaochen Dai^{26

27}, Frances E Dean^{26

28}, Sindhura Deekonda²⁹, Xueting Ding³⁰, Ojas Prakashbhai Doshi³¹, Abdel Rahman E'mar³², Muhammed Elhadi^{33

34}, Jawad Fares³⁵, Patrick Fazeli³⁶, James L Fisher³⁷, Maryam Fotouhi^{38

39}, Ali Gholamrezanezhad³⁸, Fidelia Ida⁴⁰, Chidozie Declan Iwu⁴¹, Mohamed Jalloh^{42

43}, Chinmay T Jani⁴⁴, Rizwan Kalani⁴⁵, Samuel Berchi Kankam⁴⁶, Foad Kazemi⁴⁷, Ariz Keshwani⁴⁸, Atulya Aman Khosla^{49

50}, Stephen S Lim^{26

27}, Riffat Mehboob^{51

52}, Tomislav Mestrovic^{26

53}, Ali H Mokdad^{26

27}, Christopher J L Murray^{26

27}, Gurudatta Naik⁵⁴, Zuhair S Natto^{55

56}, Dang Nguyen^{46

57}, Fred Nugen^{20

58}, Atakan Orscelik⁵⁹, Romil R Parikh⁶⁰, Louise Penberthy²⁶, Richard G Pestell^{61

62}, Disha Prabhu⁶³, Jagadeesh Puvvula⁶⁴, Shakthi Kumaran Ramasamy⁶⁵, Cameron John Sabet⁶⁶, Austin E Schumacher²⁶, Yigit Can Senol⁵⁹, Sunder Sham⁶⁷, Samendra P Sherchan^{68

69}, Gizeaddis Lamesgin Simegn⁷⁰, Jasvinder A Singh^{71

72}, Ranjan Solanki^{73

74}, Bahadar S Srichawla⁷⁵, Jabeen Taiba^{76

77}, Manoj Tanwar⁷⁸, Mike Tuffour Amirikah⁴⁶, Anjul Verma⁷⁹, Ismaeel Yunusa⁸⁰, David X Zheng⁸¹, Dong Keon Yon⁸², Keun Young Park¹

Affiliations

¹ Department of Neurosurgery, Yonsei University, Seoul, South Korea.
² Department of Medicine, Yonsei University, Seoul, South Korea.
³ Department of Biomedical Data Science, Stanford University, Stanford, California.
⁴ Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea.
⁵ Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
⁶ Massachusetts General Hospital, Boston.
⁷ Severance Hospital, Yonsei University, Seoul, South Korea.
⁸ Department of Radiation Oncology, Massachusetts General Hospital, Boston.
⁹ Department of Biochemistry and Molecular Medicine, Alfaisal University, Riyadh, Saudi Arabia.
¹⁰ College of Graduate Health Sciences, University of Tennessee, Memphis.
¹¹ College of Art and Science, Ottawa University, Surprise, Arizona.
¹² School of Life Sciences, Arizona State University, Tempe.
¹³ Department of Neurological Surgery, University of California, San Francisco.
¹⁴ ASIDE Healthcare, Lewes, Delaware.
¹⁵ Faculty of Medicine, October 6 University, 6th of October City, Egypt.
¹⁶ Miller School of Medicine, University of Miami, Miami, Florida.
¹⁷ Biological Science Division, University of Chicago, Chicago, Illinois.
¹⁸ Avicenna Biotech Research, Germantown, Maryland.
¹⁹ Department of Regulatory Affairs, Amarex Clinical Research, Germantown, Maryland.
²⁰ Department of Radiology, Mayo Clinic, Rochester, Minnesota.
²¹ Division of Hematology Oncology, University of Massachusetts Medical School, Springfield.
²² Department of Health Administration, Rutgers University, New Brunswick, New Jersey.
²³ Department of Radiology, University of Pennsylvania, Philadelphia.
²⁴ School of Dentistry, University of Michigan, Ann Arbor.
²⁵ Department of Hematology-Oncology, LSU Health Shreveport, Shreveport, Louisiana.
²⁶ Institute for Health Metrics and Evaluation, University of Washington, Seattle.
²⁷ Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle.
²⁸ Department of Mathematics, University of California, Berkeley.
²⁹ Department of Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, New York.
³⁰ Joe C. Wen School of Population & Public Health, University of California, Irvine.
³¹ Independent Consultant, South Plainfield, New Jersey.
³² Department of Pediatrics, Cleveland Clinic, Cleveland, Ohio.
³³ Faculty of Medicine, University of Tripoli, Tripoli, Libya.
³⁴ Houston Methodist Hospital, Houston, Texas.
³⁵ Department of Neurological Surgery, Northwestern University, Chicago, Illinois.
³⁶ Department of Biology and Medicine, Brown University, Providence, Rhode Island.
³⁷ James Cancer Hospital at The Ohio State University, Ohio State University, Columbus.
³⁸ Department of Radiology, University of Southern California, Los Angeles.
³⁹ Department of Medicine, Iran University of Medical Sciences, Tehran, Iran.
⁴⁰ Pharmacoepidemiology Department, Sanofi, Cambridge, Massachusetts.
⁴¹ School of Health Systems and Public Health, University of Washington, Seattle.
⁴² Department of Neurosurgery, Medical College of Wisconsin, Milwaukee.
⁴³ Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
⁴⁴ Department of Internal Medicine, Harvard University, Cambridge, Massachusetts.
⁴⁵ Department of Neurology, University of Washington, Seattle.
⁴⁶ Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
⁴⁷ Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland.
⁴⁸ Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
⁴⁹ Department of Internal Medicine, Corewell Health East William Beaumont University Hospital, Royal Oak, Michigan.
⁵⁰ Department of Medical Oncology, Miami Cancer Institute, Miami, Florida.
⁵¹ National Heart, Lung, and Blood Institute, Bethesda, Maryland.
⁵² Research and Development Department, Lahore Medical Research Center, Lahore, Pakistan.
⁵³ University Centre Varazdin, University North, Varazdin, Croatia.
⁵⁴ Department of Health Services Research, University of Alabama at Birmingham.
⁵⁵ Department of Dental Public Health, King Abdulaziz University, Jeddah, Saudi Arabia.
⁵⁶ Department of Health Policy and Oral Epidemiology, Harvard University, Boston, Massachusetts.
⁵⁷ Department of Medical Engineering, University of South Florida, Tampa.
⁵⁸ School of Information, University of California, Berkeley.
⁵⁹ Department of Neurosurgery, University of California, San Francisco.
⁶⁰ Division of Health Policy and Management, University of Minnesota, Minneapolis.
⁶¹ Pennsylvania Cancer and Regenerative Medicine Center, Baruch S. Blumberg Institute, Doylestown.
⁶² Department of Medicine, Xavier University School of Medicine, Woodbury, New York.
⁶³ Independent Consultant, San Diego, California.
⁶⁴ Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia.
⁶⁵ Department of Radiology, Stanford University, Stanford, California.
⁶⁶ Department of Medicine, Georgetown University, Washington, DC.
⁶⁷ Department of Pathology and Laboratory Medicine, Northwell Health, New York, New York.
⁶⁸ Department of Biology, Morgan State University, Baltimore, Maryland.
⁶⁹ Department of Environmental Health Sciences, Tulane University, New Orleans, Louisiana.
⁷⁰ Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland.
⁷¹ School of Medicine, Baylor College of Medicine, Houston, Texas.
⁷² Department of Medicine Service, US Department of Veterans Affairs, Houston, Texas.
⁷³ Department of Systemic Pathology, Touro College of Osteopathic Medicine, Middletown, New York.
⁷⁴ Department of Pathology, American University of the Caribbean School of Medicine, Cupecoy, Saint Martin.
⁷⁵ Department of Neurology, University of Massachusetts Medical School, Worcester.
⁷⁶ Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha.
⁷⁷ Sri Ramachandra Medical College and Research Institute, Chennai, India.
⁷⁸ Department of Radiology, University of Alabama at Birmingham.
⁷⁹ Department of Internal Medicine, Texas Tech University, Odessa.
⁸⁰ Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia.
⁸¹ Department of Medicine, Massachusetts General Hospital, Boston.
⁸² Department of Pediatrics, Kyung Hee University, Seoul, South Korea.

PMID: 41182787
PMCID: PMC12584065
DOI: 10.1001/jamaneurol.2025.4286

Burden of Central Nervous System Cancer in the United States, 1990-2021

GBD 2021 US CNS Cancer Collaborators et al. JAMA Neurol. 2025.

. 2025 Nov 3:e254286.

doi: 10.1001/jamaneurol.2025.4286. Online ahead of print.

Authors

Affiliations

¹ Department of Neurosurgery, Yonsei University, Seoul, South Korea.
² Department of Medicine, Yonsei University, Seoul, South Korea.
³ Department of Biomedical Data Science, Stanford University, Stanford, California.
⁴ Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea.
⁵ Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
⁶ Massachusetts General Hospital, Boston.
⁷ Severance Hospital, Yonsei University, Seoul, South Korea.
⁸ Department of Radiation Oncology, Massachusetts General Hospital, Boston.
⁹ Department of Biochemistry and Molecular Medicine, Alfaisal University, Riyadh, Saudi Arabia.
¹⁰ College of Graduate Health Sciences, University of Tennessee, Memphis.
¹¹ College of Art and Science, Ottawa University, Surprise, Arizona.
¹² School of Life Sciences, Arizona State University, Tempe.
¹³ Department of Neurological Surgery, University of California, San Francisco.
¹⁴ ASIDE Healthcare, Lewes, Delaware.
¹⁵ Faculty of Medicine, October 6 University, 6th of October City, Egypt.
¹⁶ Miller School of Medicine, University of Miami, Miami, Florida.
¹⁷ Biological Science Division, University of Chicago, Chicago, Illinois.
¹⁸ Avicenna Biotech Research, Germantown, Maryland.
¹⁹ Department of Regulatory Affairs, Amarex Clinical Research, Germantown, Maryland.
²⁰ Department of Radiology, Mayo Clinic, Rochester, Minnesota.
²¹ Division of Hematology Oncology, University of Massachusetts Medical School, Springfield.
²² Department of Health Administration, Rutgers University, New Brunswick, New Jersey.
²³ Department of Radiology, University of Pennsylvania, Philadelphia.
²⁴ School of Dentistry, University of Michigan, Ann Arbor.
²⁵ Department of Hematology-Oncology, LSU Health Shreveport, Shreveport, Louisiana.
²⁶ Institute for Health Metrics and Evaluation, University of Washington, Seattle.
²⁷ Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle.
²⁸ Department of Mathematics, University of California, Berkeley.
²⁹ Department of Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, New York.
³⁰ Joe C. Wen School of Population & Public Health, University of California, Irvine.
³¹ Independent Consultant, South Plainfield, New Jersey.
³² Department of Pediatrics, Cleveland Clinic, Cleveland, Ohio.
³³ Faculty of Medicine, University of Tripoli, Tripoli, Libya.
³⁴ Houston Methodist Hospital, Houston, Texas.
³⁵ Department of Neurological Surgery, Northwestern University, Chicago, Illinois.
³⁶ Department of Biology and Medicine, Brown University, Providence, Rhode Island.
³⁷ James Cancer Hospital at The Ohio State University, Ohio State University, Columbus.
³⁸ Department of Radiology, University of Southern California, Los Angeles.
³⁹ Department of Medicine, Iran University of Medical Sciences, Tehran, Iran.
⁴⁰ Pharmacoepidemiology Department, Sanofi, Cambridge, Massachusetts.
⁴¹ School of Health Systems and Public Health, University of Washington, Seattle.
⁴² Department of Neurosurgery, Medical College of Wisconsin, Milwaukee.
⁴³ Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
⁴⁴ Department of Internal Medicine, Harvard University, Cambridge, Massachusetts.
⁴⁵ Department of Neurology, University of Washington, Seattle.
⁴⁶ Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
⁴⁷ Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland.
⁴⁸ Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
⁴⁹ Department of Internal Medicine, Corewell Health East William Beaumont University Hospital, Royal Oak, Michigan.
⁵⁰ Department of Medical Oncology, Miami Cancer Institute, Miami, Florida.
⁵¹ National Heart, Lung, and Blood Institute, Bethesda, Maryland.
⁵² Research and Development Department, Lahore Medical Research Center, Lahore, Pakistan.
⁵³ University Centre Varazdin, University North, Varazdin, Croatia.
⁵⁴ Department of Health Services Research, University of Alabama at Birmingham.
⁵⁵ Department of Dental Public Health, King Abdulaziz University, Jeddah, Saudi Arabia.
⁵⁶ Department of Health Policy and Oral Epidemiology, Harvard University, Boston, Massachusetts.
⁵⁷ Department of Medical Engineering, University of South Florida, Tampa.
⁵⁸ School of Information, University of California, Berkeley.
⁵⁹ Department of Neurosurgery, University of California, San Francisco.
⁶⁰ Division of Health Policy and Management, University of Minnesota, Minneapolis.
⁶¹ Pennsylvania Cancer and Regenerative Medicine Center, Baruch S. Blumberg Institute, Doylestown.
⁶² Department of Medicine, Xavier University School of Medicine, Woodbury, New York.
⁶³ Independent Consultant, San Diego, California.
⁶⁴ Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia.
⁶⁵ Department of Radiology, Stanford University, Stanford, California.
⁶⁶ Department of Medicine, Georgetown University, Washington, DC.
⁶⁷ Department of Pathology and Laboratory Medicine, Northwell Health, New York, New York.
⁶⁸ Department of Biology, Morgan State University, Baltimore, Maryland.
⁶⁹ Department of Environmental Health Sciences, Tulane University, New Orleans, Louisiana.
⁷⁰ Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland.
⁷¹ School of Medicine, Baylor College of Medicine, Houston, Texas.
⁷² Department of Medicine Service, US Department of Veterans Affairs, Houston, Texas.
⁷³ Department of Systemic Pathology, Touro College of Osteopathic Medicine, Middletown, New York.
⁷⁴ Department of Pathology, American University of the Caribbean School of Medicine, Cupecoy, Saint Martin.
⁷⁵ Department of Neurology, University of Massachusetts Medical School, Worcester.
⁷⁶ Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha.
⁷⁷ Sri Ramachandra Medical College and Research Institute, Chennai, India.
⁷⁸ Department of Radiology, University of Alabama at Birmingham.
⁷⁹ Department of Internal Medicine, Texas Tech University, Odessa.
⁸⁰ Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia.
⁸¹ Department of Medicine, Massachusetts General Hospital, Boston.
⁸² Department of Pediatrics, Kyung Hee University, Seoul, South Korea.

PMID: 41182787
PMCID: PMC12584065
DOI: 10.1001/jamaneurol.2025.4286

Abstract

Importance: Primary brain and central nervous system cancer (collectively referred to as CNS cancer) comprises 2% of all human cancers and poses significant health and economic challenges in the United States.

Objective: To analyze CNS cancer burden in the US, stratified by time, location (state and division), sex, age group, and Sociodemographic Index (SDI).

Design, setting, and participants: This cross-sectional study involved a repeated analysis of Global Burden of Disease Study (GBD) 2021 data in 2024. Using data from 183 sources, CNS cancer metrics in the US were estimated across states and years. US CNS cancer metrics across all sexes and age groups were included in the GBD.

Exposure: CNS cancer diagnosis.

Main outcomes and measures: Overall and age-standardized estimates of the incidence, prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost, and years lived with disability per 100 000 population, including 95% uncertainty intervals (UIs), and time trends.

Results: In 2021, for all age groups and sexes across the US, there were 31 780 incident cases (95% UI, 29971.1 to 32843.9). Age-standardized incidence, DALYs, and mortality rates per 100 000 population were 6.91 (95% UI, 6.58 to 7.12), 134.38 (95% UI, 129.83 to 137.95), and 4.1 (95% UI, 3.87 to 4.22), respectively. Despite no significant change observed in the overall incidence between 1990 and 2021, DALY and mortality rates decreased by 15.77% (95% UI, -17.75% to -13.68%) and 8.41% (95% UI, -11.09% to -6.22%), respectively. Substantial geographic variability was noted. Mississippi, Alabama, Kentucky, and Kansas (West North Central and East South Central divisions) and West Virginia faced persistently high burdens over the past 30 years. Sex differences were evident; disease burden was consistently higher in males compared with females. Age-specific estimates showed a bimodal distribution: the youngest group (<5 years) showed a significant decrease in incidence rate (-34.42% to -11.56%), whereas older age groups (>70 years) experienced increasing trends. DALYs and mortality rates were negatively correlated with SDI (ρ = -0.6860 and ρ = -0.6391; P < .001).

Conclusions and relevance: These findings provide valuable insights into the CNS cancer burden across the US by age, sex, location, and SDI, enabling better public health status assessments, health care policy restructuring, and resource redistribution for improved care.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Shin reported support from the Yonsei Fellowship, funded by Lee Youn Jae (JIS), outside the submitted work. Dr Kalani reported grants from the National Institutes of Health (NIH; R01NS138297) outside the submitted work. Dr Singh reported consultant fees from ROMTech, Atheneum, Clearview Healthcare Partners, Yale, Hulio, Horizon Pharmaceuticals/DINORA, ANI/Exeltis, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs Inc, Adept Field Solutions, Clinical Care Options, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, Practice Point Communications, NIH, and American College of Rheumatology (ACR); institutional research support from Zimmer Biomet Holdings; other payments and/or support from Intuitive Surgical Inc/Philips Electronics North America, Atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics Inc, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp, Aebona Pharmaceuticals, and Charlotte’s Web Holdings; stock options current or previous from Amarin, Viking, and Moderna Pharmaceuticals; speakers bureau fees from Simply Speaking; and being a member of the ACR Annual Meeting Planning Committee and Quality of Care Committees, chair of the ACR Meet-the-Professor, Workshop, and Study Group Subcommittee, co-chair of the ACR Criteria and Response Criteria subcommittee, executive of Outcomes Measures in Rheumatology, and previous member of the US Food and Drug Administration arthritis advisory committee outside the submitted work. Dr Tanwar reported grants from University of Alabama at Birmingham outside the submitted work. No other disclosures were reported.

Figures

**Figure 1.. Central Nervous System Cancer Burden Across US States, 2021**
Age-standardized rates for incidence (A), disability-adjusted life-years (DALYs) (B), and mortality (C) per 100 000 population of central nervous system cancer in the US, 2021.

**Figure 2.. Sex-Stratified Trends of Central Nervous System Cancer Burden in the US**
Incidence (A), disability-adjusted life-years (DALYs) (B), death count (C), and age-standardized rates per 100 000 population by sex, 1990-2021. Error bars indicate 95% uncertainty intervals.

**Figure 3.. Age- and Sex-Stratified Trends of Central Nervous System Cancer Burden in the US**
Incidence (A),disability-adjusted life-years (DALYs) (B), death count (C), and rates per 100 000 population by sex and age, 2021. Error bars indicate 95% uncertainty intervals.

Figure 4.. Correlation of Sociodemographic Index (SDI) With Age-Standardized Rates of Incidence, Disability-Adjusted Life-Years (DALYs), and Mortality per 100 000 Population of Central Nervous System Cancer in the US
Incidence (A), DALYs (B), and death (C) by state SDI, 2021. Incidence (D), DALYs (E), and death (F) by nation and region SDI, 1990–2021. The yearly average SDI and DALY rates for each division from 1990 to 2021 were calculated. The year-wise notation of each datapoint has not been marked. Trendlines for panels A-C and D-F indicate linear and locally weighted scatterplot smoothing regression trendlines, respectively.

See this image and copyright information in PMC

References

1. Lapointe S, Perry A, Butowski NA. Primary brain tumours in adults. Lancet. 2018;392(10145):432-446. doi: 10.1016/S0140-6736(18)30990-5 - DOI - PubMed
1. Schubart JR, Kinzie MB, Farace E. Caring for the brain tumor patient: family caregiver burden and unmet needs. Neuro Oncol. 2008;10(1):61-72. doi: 10.1215/15228517-2007-040 - DOI - PMC - PubMed
1. Olesen J, Gustavsson A, Svensson M, Wittchen HU, Jönsson B; CDBE2010 study group; European Brain Council . The economic cost of brain disorders in Europe. Eur J Neurol. 2012;19(1):155-162. doi: 10.1111/j.1468-1331.2011.03590.x - DOI - PubMed
1. Khanmohammadi S, Mobarakabadi M, Mohebi F. The economic burden of malignant brain tumors. In: Rezaei N, Nanaei S, eds. Human Brain and Spinal Cord Tumors: From Bench to Bedside Volume 1: Neuroimmunology and Neurogenetics. Springer; 2023:209-221. - PubMed
1. Raizer JJ, Fitzner KA, Jacobs DI, et al. Economics of malignant gliomas: a critical review. J Oncol Pract. 2015;11(1):e59-e65. doi: 10.1200/JOP.2012.000560 - DOI - PMC - PubMed

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Burden of Central Nervous System Cancer in the United States, 1990-2021

Affiliations

Burden of Central Nervous System Cancer in the United States, 1990-2021

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Miscellaneous