Background: Metastatic brain tumors (MBTs) are the most common intracranial malignancy in adults and remain associated with poor survival despite advances in systemic therapies and radiation modalities. Although racial disparities in cancer outcomes are well documented, the interaction between race and socioeconomic status among patients with brain metastases has not been well characterized. Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database from 2010-2022. Adult patients with brain metastases originating from lung, breast, melanoma, or prostate cancer were included. Logistic regression models evaluated disparities in receipt of chemotherapy, radiation therapy, and multimodal treatment. Cox proportional hazards models assessed cancer-specific survival. Models incorporated race × income interaction terms and were parameterized using White patients with household income ≥ $75,000 as the reference group. Results: A total of 77,895 patients were included (lung n = 69,932; melanoma n = 3786; breast n = 3588; prostate n = 593). In lung cancer MBTs, low-income Black patients had higher mortality risk (HR 1.12, 95% CI 1.08 - 1.16, p < 0.001), while high-income Hispanic patients had improved survival (HR 0.91, 95% CI 0.87 - 0.95, p < 0.001). Asian patients demonstrated significantly improved survival across both income strata. In breast cancer MBTs, Black patients experienced significantly worse survival regardless of income (high-income HR 1.23, p = 0.008; low-income HR 1.33, p < 0.001). Treatment analyses revealed lower odds of multimodal therapy among low-income Black patients and reduced radiation therapy utilization among Hispanic patients across multiple cancer types. Conclusions: Socioeconomic status modifies racial disparities in treatment receipt and survival among patients with brain metastases. Persistent survival differences in breast cancer highlight the importance of addressing structural inequities in metastatic cancer care.
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