The global, regional, and national early-onset colorectal cancer burden and trends from 1990 to 2019: results from the Global Burden of Disease Study 2019

Abstract

Purpose: The incidence of early-onset colorectal cancer (EO-CRC), which occurs in people under age 50, has been increasing annually. The aim of this study was to provide an up-to-date estimate of the global EO-CRC burden.

Methods: We used Global Burden of Disease Study data and methodologies to describe changes in the EO-CRC burden from 1990 to 2019, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs). The driving factors for cancer burden variation were further analyzed using decomposition analysis. Frontier analysis was used to visually demonstrate the potential for burden reduction in each country or region based on their development levels.

Results: The global EO-CRC incidence more than doubled, increasing from 95,737 (95% uncertainty interval (UI): 90,838-101.042) /100,000 in 1990 to 226,782 (95% UI: 207,495-248,604) /100,000 in 2019. Additionally, related deaths increased from 50,997 (95% UI: 47,692-54,410) /100,000 to 87,014 (95% UI: 80,259-94,339) /100,000, and DALYs increased from 256,1842 (95% UI: 239,4962-2,735,823) /100,000 to 4,297,573 (95% UI: 3,965,485-4,650,790) /100,000. Regarding age-standardized rates, incidence and prevalence increased significantly, while mortality and DALYs rate were basically unchanged. Decomposition analysis showed a significant increase in DALYs in the middle sociodemographic index (SDI) quintile region, in which aging and population growth played a major driving role. Frontier analysis showed that countries or regions with a higher SDI quintile tend to have greater improvement potential.

Conclusion: The current EO-CRC burden was found to be the greatest in the high-middle SDI quintile region and East Asia, which may need to adjust screening guidelines accordingly and introduce more effective interventions.

Keywords: Disability-adjusted life years (DALYs); Early-onset colorectal cancer (EO-CRC); Global Burden of Disease (GBD); Incidence; Mortality; Prevalence.

Fig. 1

The incidence of early-onset colorectal cancer for both sexes in 204 countries and territories. A The age-standardized incidence of early-onset colorectal cancer in 2019; B The AAPC of age-standardized incidence of early-onset colorectal cancer from 1990 to 2019. AAPC, average annual percentage change

Fig. 2

The prevalence of early-onset colorectal cancer for both sexes in 204 countries and territories. A The age-standardized prevalence of early-onset colorectal cancer in 2019; B The AAPC of age-standardized prevalence of early-onset colorectal cancer from 1990 to 2019. AAPC, average annual percentage change

Fig. 3

The mortality of early-onset colorectal cancer for both sexes in 204 countries and territories. A The age-standardized mortality of early-onset colorectal cancer in 2019; B The AAPC of age-standardized mortality of early-onset colorectal cancer from 1990 to 2019. AAPC, average annual percentage change

Fig. 4

The DALYs of early-onset colorectal cancer for both sexes in 204 countries and territories. A The age-standardized DALYs of early-onset colorectal cancer in 2019; B The AAPC of age-standardized DALYs of early-onset colorectal cancer from 1990 to 2019. ASR, age-standardized rate; AAPC, average annual percentage change; DALYs, Disability-Adjusted Life Years

Fig. 5

The number of incidence, prevalence, deaths and DALYs due to early-onset colorectal cancer grouped by SDI quintiles for different sexes from 1990 to 2019. SDI: Socio-demographic index; DALYs, Disability-Adjusted Life Years

Fig.6

Age-standardized incidence, prevalence, mortality and DALYs per 100 000 people of early-onset colorectal cancer grouped by SDI quintiles for different sexes from 1990 to 2019. SDI: Socio-demographic index; DALYs, Disability-Adjusted Life Years

Fig. 7

Changes in early-onset colorectal cancer DALYs according to population-level determinants of population growth, aging, and epidemiological change from 1990 to 2019 at the global level and by SDI quintile. The black dot represents the overall value of change contributed by all 3 components. For each component, the magnitude of a positive value indicates a corresponding increase in early-onset colorectal cancer DALYs attributed to the component; the magnitude of a negative value indicates a corresponding decrease in early-onset colorectal cancer DALYs attributed to the related component. SDI: Socio-demographic index; DALYs, Disability-Adjusted Life Years

Fig. 8

Frontier analysis based on SDI and age-standardized early-onset colorectal cancer DALY rate in 2019. The frontier is delineated in solid black color; countries and territories are represented as dots. The top 15 countries with the largest effective difference (largest early-onset colorectal cancer DALYs gap from the frontier) are labeled in black; examples of frontier countries with low SDI (< 0.5) and low effective difference are labeled in blue (e.g., Somalia, Niger, Nepal, Bangladesh, and the Gambia), and examples of countries and territories with high SDI (> 0.85) and relatively high effective difference for their level of development are labeled in red (e.g., USA, Japan, Andorra, Monaco, Taiwan (province of China). Red dots indicate an increase in age-standardized early-onset colorectal cancer DALYs rate from 1990 to 2019; blue dots indicate a decrease in age-standardized early-onset colorectal cancer DALYs rate between 1990 and 2019. SDI: Socio-demographic index; DALYs: Disability-Adjusted Life Years