Childhood and Adolescent Central Nervous System Tumour Mortality in the United States, 1999– 2024: A CDC WONDER Joinpoint Analysis and Surveillance Model for Pakistan

Abstract

Objective: Central nervous system (CNS) tumours are the leading cause of cancer-related mortality among children and adolescents worldwide, surpassing leukaemia. Pakistan has a predominantly young population but lacks a national cancer mortality registry. This study aimed to characterize temporal trends and sex disparites in childhood and adolescent CNS tumour mortality in the United States and propose a reproducible surveillance model applicable to registry-lacking settings such as Pakistan.

Methods: A retrospective population-based ecological ti me-trend study was conducted using CDC WONDER mortality data for individuals aged 0–19 years from 1999 to 2024, including race-bridged files (1999 - 2020) and single-race files (2021- 2024). Crude mortality rates per 100,000 population were analyzed by sex using Joinpoint regression. Annual Percent Change (APC), Average Annual Percent Change (AAPC), and 95% confidence intervals were calculated. Tests of parallelism and coincidence assessed sex-specific trend differences. Reporting followed the STROBE guideline.

Results: A total of 13,901 CNS tumour-related deaths were identified, including 7,547 males and 6,354 females. Overall mortality declined from 0.68 to 0.63 per 100,000, demonstrating a single-segment trend without joinpoints (AAPC -0.31%; 95% CI -0.61 to -0.01; p=0.044). No significant sex-specific differences in temporal decline were observed (female AAPC -0.25%; male AAPC -0.32%). Mortality trends were parallel (p=0.82); however, male mortality remained consistently higher than female mortality throughout the study (coincidence p=0.0002), with an overall period rate ratio of 1.13 (0.69 vs. 0.61 per 100,000). 

Conclusion: Childhood and adolescent CNS tumour mortality in the United States demonstrated a modest but significant decline between 1999 and 2024, while maintaining a persistent male predominance. This populationbased analysis provides an evidence-based framework for monitoring paediatric neuro-oncology outcomes and offers a scalable surveillance model for countries without national cancer mortality registries, including Pakistan