Introduction: Multiple myeloma (MM) is a plasma cell malignancy that predominantly affects older adults. Global disparities in diagnosis, access to care, and mortality are well documented, particularly in low- and middle-income countries. In Brazil, socioeconomic and geographic heterogeneity may influence outcomes. Understanding long-term patterns is essential for guiding equitable public health strategies.

Methods: We conducted an ecological study using mortality data from the Mortality Information System (SIM) and population estimates from the Brazilian Institute of Geography and Statistics (IBGE). Mortality rates due to MM among individuals aged ≥40 years were analyzed from 1997 to 2023 and stratified by sex, age, race, region, and occupation. Temporal trends were assessed using Joinpoint regression, and age–period–cohort (APC) models explored cohort and period effects.

Results: A total of 63,105 MM deaths were recorded. Men accounted for 51.2% of deaths. Age-adjusted mortality increased from 0.40 per 100,000 in 1997 to 0.85 in 2023. White individuals represented 60% of deaths, followed by mixed-race (26%) and Black individuals (7.8%). Mortality was highest among construction workers (10%) and agricultural, livestock, forestry, and fishing workers (8.2%). APC analysis showed increased relative risk in male cohorts born around 1990 and a recent rise among females (male RR: 1.45; female RR: 1.53). Joinpoint analyses indicated declining trends for males (−1.87%; 95% CI: −2.52 to −1.19) and smaller reductions for females (−0.43%; 95% CI: −0.65 to −0.21), with sharper declines in ages 40–49.

Conclusions: MM mortality in Brazil increased overall from 1997 to 2023, with greater rises among men. Elevated mortality among construction workers and white individuals highlights the need for targeted policies addressing occupational risks, regional disparities, and timely access to diagnosis and treatment.