Trends in and Predictions of Colorectal Cancer Incidence and Mortality in China From 1990 to 2025

Abstract

Colorectal cancer (CRC) has emerged as a major public health concern in China during the last decade. In this study, we investigated the disease burden posed by CRC and analyzed temporal trends in CRC incidence and mortality rates in this country. We collected CRC incidence data from the Cancer Incidence in Five Continents, Volume XI dataset and the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of CRC by sex and age, from the 2016 Global Burden of Diseases Study. We used the average annual percentage change (AAPC) to quantify temporal trends in CRC incidence and mortality from 1990 to 2016 and found the ASIR of CRC increased from 14.25 per 100,000 in 1990 to 25.27 per 100,000 in 2016 (AAPC = 2.34, 95% confidence interval [CI] 2.29, 2.39). Cancer cases increased from 104.3 thousand to 392.8 thousand during the same period. The ASIR increased by 2.76% (95% CI 2.66%, 2.85%) and 1.70% (95% CI 1.64%, 1.76%) per year in males and females, respectively. The highest AAPC was found in people aged 15-49 years (2.76, 95% CI 2.59, 2.94). Cancer deaths increased from 81.1 thousand in 1990 to 167.1 thousand in 2016, while the ASMR remained stable (-0.04, 95% CI -0.13, 0.05), A mild increase (AAPC = 0.42, 95% CI 0.34, 0.51) was found among males and a significant decrease (AAPC = -0.75, 95% CI -0.90, -0.60) was found among females. Between 2016 and 2025, cancer cases and deaths are expected to increase from 392.8 and 167.1 thousand in 2016 to 642.3 (95% CI 498.4, 732.1) and 221.1 thousand (95% CI 122.5, 314.8) in 2025, respectively. Our study showed a steady increase in the CRC incidence in China over the past three decades and predicted a further increase in the near future. To combat this health concern, the prevention and management of known risk factors should be promoted through national polices. Greater priority should be given to CRC prevention in younger adults, and CRC screening should be widely adopted for this population.

Keywords: China; colorectal cancer; incidence; mortality; prediction.

Figure 1

(A) The geographical distribution of the age-standardized incidence rate (ASIR) per 100,000 colorectal cancer cases in China. The deeper the color, the higher the rate. The white areas indicate no data were mapped. (B) The cancer registries included in this analysis. (BJ, Beijing; TJ, Tianjin; HB, Hebei; NMG, Inner Mongolia; SX, Shanxi; HLJ, Heilongjiang; JL, Jilin; LN, Liaoning; SD, Shandong; JS, Jiangsu; SH, Shanghai; ZJ, Zhejiang; AH, Anhui; FJ, Fujian; JX, Jiangxi; GD, Guangdong; GX, Guangxi; HaN, Hainan; YN, Yunnan; GZ, Guizhou; XZ, Tibet; SC, Sichuan; QC, Chongqing; HuN, Hunan; HuB, Hubei; HN, Henan; SaX, Shaanxi; GS, Gansu; NX, Ningxia; QH, Qinghai; XJ, Xinjiang).

Figure 2

The temporal trends of the (A) age-standardized incidence rate, (B) age-standardized mortality rate, by sex, from 1990 to 2016. The AAPCs presented in (A,B) were derived from a period-specific data: (A) 1990–2010 and 2011–2016; (B) 1990–2002 and 2003–2016.

Figure 3

The temporal trends of CRC death rate, stratified by risk factor, in China from 1990 to 2016.

Figure 4

The temporal trends of the (A) Disability-Adjusted Life Years (DALYs), (B) Years Lived with Disability (YLDs), and (C) Years with Life Lost (YLLs) of CRC stratified by sex in China from 1990 to 2016. (pys, person years).

Figure 5

The projections of colorectal cancer cases (A) and deaths (B), by sex, from 2017 to 2025 in China.