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. 2022 Jul;7(7):627-647.
doi: 10.1016/S2468-1253(22)00044-9. Epub 2022 Apr 7.

Global, regional, and national burden of colorectal cancer and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

GBD 2019 Colorectal Cancer Collaborators
Collaborators

Global, regional, and national burden of colorectal cancer and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

GBD 2019 Colorectal Cancer Collaborators. Lancet Gastroenterol Hepatol. 2022 Jul.

Erratum in

Abstract

Background: Colorectal cancer is the third leading cause of cancer deaths worldwide. Given the recent increasing trends in colorectal cancer incidence globally, up-to-date information on the colorectal cancer burden could guide screening, early detection, and treatment strategies, and help effectively allocate resources. We examined the temporal patterns of the global, regional, and national burden of colorectal cancer and its risk factors in 204 countries and territories across the past three decades.

Methods: Estimates of incidence, mortality, and disability-adjusted life years (DALYs) for colorectal cancer were generated as a part of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019 by age, sex, and geographical location for the period 1990-2019. Mortality estimates were produced using the cause of death ensemble model. We also calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer.

Findings: Globally, between 1990 and 2019, colorectal cancer incident cases more than doubled, from 842 098 (95% uncertainty interval [UI] 810 408-868 574) to 2·17 million (2·00-2·34), and deaths increased from 518 126 (493 682-537 877) to 1·09 million (1·02-1·15). The global age-standardised incidence rate increased from 22·2 (95% UI 21·3-23·0) per 100 000 to 26·7 (24·6-28·9) per 100 000, whereas the age-standardised mortality rate decreased from 14·3 (13·5-14·9) per 100 000 to 13·7 (12·6-14·5) per 100 000 and the age-standardised DALY rate decreased from 308·5 (294·7-320·7) per 100 000 to 295·5 (275·2-313·0) per 100 000 from 1990 through 2019. Taiwan (province of China; 62·0 [48·9-80·0] per 100 000), Monaco (60·7 [48·5-73·6] per 100 000), and Andorra (56·6 [42·8-71·9] per 100 000) had the highest age-standardised incidence rates, while Greenland (31·4 [26·0-37·1] per 100 000), Brunei (30·3 [26·6-34·1] per 100 000), and Hungary (28·6 [23·6-34·0] per 100 000) had the highest age-standardised mortality rates. From 1990 through 2019, a substantial rise in incidence rates was observed in younger adults (age <50 years), particularly in high Socio-demographic Index (SDI) countries. Globally, a diet low in milk (15·6%), smoking (13·3%), a diet low in calcium (12·9%), and alcohol use (9·9%) were the main contributors to colorectal cancer DALYs in 2019.

Interpretation: The increase in incidence rates in people younger than 50 years requires vigilance from researchers, clinicians, and policy makers and a possible reconsideration of screening guidelines. The fast-rising burden in low SDI and middle SDI countries in Asia and Africa calls for colorectal cancer prevention approaches, greater awareness, and cost-effective screening and therapeutic options in these regions.

Funding: Bill & Melinda Gates Foundation.

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Conflict of interest statement

Declaration of interests R Ancuceanu reports consulting fees from AbbVie; payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing, or educational events from AbbVie, Sandoz, and B Braun; all outside the submitted work. M Ausloos reports grants from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084 “Understanding and modelling time-space patterns of psychology-related inequalities and polarization” (October, 2018, to September, 2022), outside the submitted work. J Conde reports grants from the European Research Council Starting Grant (ERC-StG-2019-848325); patents planned, issued or pending for functionalised nanoparticles and compositions for cancer treatment and methods (US Application No. 62/334538), and TRPV2 Antagonists WO Application No. PCT/PT2018/050035; all outside the submitted work. I Fillip reports consulting fees from Avicenna Medical and Clinical Research Institute, outside the submitted work. N Ghith reports grants from Novo Nordisk Foundation as salary payment (NNF16OC0021856), outside the submitted work. A Guha reports grants from the American Heart Association as the Strategically Focused Research Network Grant in Disparities in Cardio-Oncology (#847740 and #863620), outside the submitted work. C Herteliu and A Pana report grants or contracts from Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084 (October, 2018, to September, 2022) “Understanding and modelling time-space patterns of psychology-related inequalities and polarization” and Project number PN-III-P2-2·1-SOL-2020-2-0351 (June to October, 2020) “Approaches within public health management in the context of COVID-19 pandemic”, all outside the submitted work. C Herteliu reports grants from the Ministry of Labour and Social Justice, Romania, project number 30/PSCD/2018, “Agenda for skills Romania 2020–2025;” outside the submitted work. J Jozwiak reports payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing, or educational events from Teva, Amgen, Synexus, Boehringer Ingelheim, Alab Laboratories, and Zentiva as personal fees, all outside the submitted work. J H Kauppila reports grants from the Sigrid Juselius Foundation and Finnish Cancer Foundation as research grants paid to their institutions; all outside the submitted work. J A Loureiro reports support for the present manuscript from Fundação para a Ciência e Técnologia (FCT) as a salary payment under the Scientific Employment Stimulus (CEECINST/00049/2018) and from FCT/MCTES (Ministério da Ciência, Tecnologia e Ensino Superior) (PIDDAC) as Base Funding (UIDB/00511/2020 of LEPABE). A-F A Mentis reports grants or contracts from ELIDEK (Hellenic Foundation for Research and Innovation, MIMS-860) and EPANEK - MilkSafe (Τ2ΕΔΚ-02222), all outside the submitted manuscript. O O Odukoya reports support for the present manuscript from the Fogarty International Center of the National Institutes of Health under the award number K43TW010704. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. A Radfar reports consulting fees from Avicenna Medical and Clinical Research Institute; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid with MEDICHEM as a board member; all outside the submitted work. M Šekerija reports payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing, or educational events from Roche and Johnson & Johnson, outside the submitted work. D A S Silva reports support for the present manuscript in part from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001 and in part by Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil (CNPq - 302028/2018-8), as payments made to their institution. J A Singh reports consulting fees from Crealta/Horizon, Medisys, Fidia, Two labs, Adept Field Solutions, Clinical Care Options, ClearView Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, UBM, Trio Health, Medscape, WebMD, and Practice Point Communications; and the National Institutes of Health and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Simply Speaking; support for attending meetings or travel, or both from OMERACT, an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, when traveling to OMERACT meetings; participation on a data safety monitoring board or advisory board as a member of the FDA Arthritis Advisory Committee; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with OMERACT as a member of the steering committee, with the Veterans Affairs Rheumatology Field Advisory Committee as a member, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as a director and editor; stock or stock options in TPT Global Tech, Vaxart Pharmaceuticals and Charlotte's Web Holdings, and previously owned stock options in Amarin, Viking, and Moderna Pharmaceuticals; all outside the submitted work. M Solmi reports payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing, or educational events from Lundbeck; and participation on a data safety monitoring board or advisory board with Angelini; all outside the submitted work. T Vos reports support for the present manuscript from the Bill & Melinda Gates Foundation as payment to their institution. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Global temporal patterns of colorectal cancer burden, 1990–2019 (A) All-age counts. (B) Age-standardised rates. Data source: Global Burden of Diseases, Injuries, and Risk Factors Study 2019. DALYs=disability-adjusted life-years.
Figure 2
Figure 2
Age-standardised rates of colorectal cancer in 2019, by sex and region (A) Age-standardised incidence rate (per 100 000 person-years). (B) Age-standardised mortality rate (per 100 000 person-years). Error bars denote 95% uncertainty intervals. Data source: Global Burden of Diseases, Injuries, and Risk Factors Study 2019.
Figure 3
Figure 3
Region-wise percentage change in colorectal cancer burden, 1990–2019 (A) All-age numbers. B) Age-standardised rate (per 100 000). Data source: Global Burden of Diseases, Injuries, and Risk Factors Study 2019. Error bars denote 95% uncertainty intervals. DALYs=disability-adjusted life-years.
Figure 4
Figure 4
Geographical distribution of age-standardised rates of colorectal cancer in 2019 (A) Age-standardised incidence rate. (B) Age-standardised mortality rate. (C) Age-standardised DALY rate. Data source: Global Burden of Diseases, Injuries, and Risk Factors Study 2019. DALY=disability-adjusted life-year.
Figure 5
Figure 5
Age-specific burden of colorectal cancer in 2019 (A) Incident cases. (B) Age-specific incidence rate (per 100 000). Error bars denote 95% uncertainty intervals. Data source: Global Burden of Diseases, Injuries, and Risk Factors Study 2019.
Figure 6
Figure 6
Percentage contribution of risk factors to all-age DALYs of colorectal cancer in 2019, for both sexes, globally and by regions Data source: Global Burden of Diseases, Injuries, and Risk Factors Study 2019. DALYs=disability-adjusted life-years.
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