Global Burden, Development-Related Inequalities, and Projections of Brain and Central Nervous System Cancer, 1990-2050: Implications for Cancer Control

IntroductionBrain and central nervous system (CNS) cancers require specialized care. Evidence linking temporal trends, development-related disparities, and future patient volumes is needed for surveillance and service planning.MethodsThis composite ecological study integrated GLOBOCAN 2022, Global Burden of Disease Study 2023 (GBD 2023), Human Development Index (HDI) data, health-system indicators, and population projections. Estimated annual percentage changes (EAPCs) quantified 1990-2023 trends, with segmented regression assessing slope changes. Population-weighted slope, relative, and concentration indices quantified HDI-related inequality; models adjusted HDI associations for universal health coverage (UHC) and physician density. Bayesian age-period-cohort (BAPC) models projected age-standardised rates and counts to 2050, with temporal holdout testing for 2016-2023.ResultsGLOBOCAN estimated 321,731 new cases and 248,500 deaths in 2022. In GBD 2023, global age-standardised incidence was stable on average over 1990-2023 (EAPC, 0.032%; 95% confidence interval [CI], -0.005 to 0.070), whereas mortality declined (-0.216%; 95% CI, -0.262 to -0.170). Segmented models identified slope changes around 1998 for incidence and 2000 for mortality. Recorded incidence and mortality were concentrated toward higher-HDI countries; concentration indices were 0.214 (95% CI, 0.146-0.269) and 0.157 (95% CI, 0.097-0.218), respectively. Adjustment for physician density attenuated the HDI coefficients by 55.7% for incidence and 54.1% for mortality, but both remained positive. By 2050, posterior median annual counts were approximately 605,000 incident cases (95% uncertainty interval [UI], 292,000-1,213,000) and 351,000 deaths (168,000-692,000).ConclusionsStable average age-standardised incidence and declining mortality, with historical slope changes, coexist with a projected rise in absolute burden. Cancer control strategies should distinguish improvements in case ascertainment from changes in underlying risk and use projections as conditional planning estimates.