Time Trend and Association of Early-Onset Colorectal Cancer with Diverticular Disease in the United States: 2010-2021

Abstract

Purpose: To examine time trends of incidence rates of EOCRC from 2010 to 2021 among patients with and without diverticular disease and to examine whether diverticular disease is associated with increased risk of EOCRC. Methods: This is a retrospective cohort study of 46,179,351 young adults aged 20−49, including 298,117 with diverticular disease. We examined yearly incidence rate of first diagnosis of EOCRC from 2010 through 2021 among patients with and without diverticular disease. The 5-year risk of EOCRC among patients with pre-existing diverticular disease was compared to propensity-matched patients without diverticular disease and EOCRC and odds ratio (OR) and 95% confidence interval (CI) were calculated. Results: The yearly incidence rate of new diagnosis of EOCRC (measured as new cases per 100,000 people per year) in young adults with pre-existing diverticular disease increased from 100 in 2010 to 402 in 2021, 4−6 times higher than in those without diverticular disease (24 in 2010 to 77 in 2021) (p < 0.001). Patients with diverticular disease were at higher risk for EOCRC than those without (OR: 1.76, 95% CI: 1.40−2.32). Conclusion: The incidence of EOCRC continuously increased from 2010 through 2021 in patients with and without diverticular disease and was 4−6 times higher among patients with diverticular disease. Patients with pre-existing diverticular disease were at a significantly increased risk for EOCRC.

Keywords: diverticular disease; early-onset colorectal cancer; electronic health records.

Figure 1

Yearly incidence rate of diverticular disease (measured by new cases per 100,000 people per year) between 2010 and 2021 among young adults aged 20–49.

Figure 2

Yearly incidence rate of EOCRC (measured by new cases per 100,000 people per year) between 2010 and 2021 among young adults (age 20–49) with and without diverticular disease.

Figure 3

Comparison of 5-year risk of EOCRC in propensity-score-matched Diverticular disease (+) and Diverticular disease (−) cohorts for 7 study populations (age 20–44). Cohorts were propensity-score matched for potential confounders including demographics (age, gender, race, ethnicity), adverse socioeconomic determinants of health and lifestyles, comorbidities, and medications. First-time diagnosis of EOCRC was followed for 5 years, for example from 2016 after the diagnosis of diverticular disease through 2021 for the 2016 study population.