Purposes <p>This study aims to explore racial or ethnic differences in incidence, treatment, and prognosis among adult intracranial meningioma patients.</p> Methods <p>Patients were selected from the SEER database. Average annual age-adjusted incidence rates (AAAIRs) were calculated. Chi-square tests assessed incidence differences between females and males. Logistic and Cox regression were used to identify the impact of race or ethnicity on treatment and prognosis. Additionally, mediation analyses were performed to examine the mediating effect of socioeconomic variables.</p> Results <p>This study enrolled 86574 patients. For non-Hispanic races, non-Hispanic Black (NHBlack) had the highest AAAIRs for grade I and II meningiomas. While for Hispanic races, Hispanic White (HWhite) had the highest AAAIRs for meningiomas of all grades. Almost all Hispanic races had lower AAAIRs compared to corresponding non-Hispanic races for meningiomas of all grades. Females had significantly higher AAAIRs than males for grade I and II meningiomas. As for treatment, compared to non-Hispanic White (NHWhite) patients, HWhite patients were more likely to receive surgery, any radiotherapy, and radiotherapy without surgery. And only NHBlack patients exhibited worse OS at 3, 12, and 60&#xa0;months compared to NHWhite in full adjustment models. The mediation analyses showed that marital status, median household income, and rural–urban continuum code partially mediate the association between race and survival.</p> Conclusions <p>Racial or ethnic disparities exist in the incidence, treatment, and survival of adult intracranial meningioma patients. Further studies are needed to understand racial or ethnic differences and improve prognosis for all meningioma patients.</p>