Global, regional, and national burden of very early-onset colorectal cancer and its risk factors from 1990 to 2019: A systematic analysis for the global burden of disease study 2019

Abstract

Aims: Very early-onset colorectal cancer (EOCRC) was defined as CRC diagnosed before the age of 35 proposed by the latest EOCRC management guideline. Until now, the disease burden of very EOCRC has never been reported. This study aimed to explore the burden of very EOCRC across the past three decades.

Methods: We extracted the data from Global Burden of Disease Study to analyze the disease burden of very EOCRC. Risk factors for the burden of deaths and disability-adjusted life years (DALYs) due to very EOCRC were also explored in this study. Additionally, decomposition analysis and frontier analysis were also conducted.

Results: Despite regional and gender variations, the global very EOCRC incidence cases increased from 21,874 (95 % UI: 20,386-23,470) to 41,545 (95 % UI: 37,978-45,523). Besides, the deaths cases also increased from 11,445 (95 % UI: 10,545-12,374) to 15,486 (95 % UI: 14,289-16,803), and the DALYs cases increased from 718,136 (95 % UI: 659,858-778,283) to 961,460 (95 % UI: 886,807-1,042,734). Decomposition analysis revealed the epidemiological change contributed most to the incidence burden of very EOCRC. Countries or regions with Sociodemographic Index (SDI) between 0.4 and 0.8 had greater disease burden improvement potential through frontier analysis. Diet low in milk, diet low in calcium, alcohol use, and high body-mass index were the main contributors to deaths and DALYs.

Conclusions: The increase in CRC burden among populations younger than 35 years globally requires vigilance from policy makers, physicians, and young individuals themselves, especially those regions experiencing faster growth burden of very EOCRC.

Keywords: Colorectal cancer; Disease burden; Risk factor.

Fig. 1

The count of incidence, deaths, and DALYs of very EOCRC grouped by SDI quintiles based on different genders from 1990 to 2019. DALYs: Disability-adjusted life years; EOCRC: Early-onset colorectal cancer; SDI: Sociodemographic Index.

Fig. 2

The ASR of incidence, deaths, and DALYs of very EOCRC grouped by SDI quintiles based on different genders from 1990 to 2019. ASR: Age-standardized rate; DALYs: Disability-adjusted life years; EOCRC: Early-onset colorectal cancer; SDI: Sociodemographic Index.

Fig. 3

The ASR of incidence (A), deaths (B), and DALYs (C) of very EOCRC in 21 GBD regions in 2019 based on different genders. ASR: Age-standardized rate; DALYs: Disability-adjusted life years; EOCRC: Early-onset colorectal cancer; GBD: Global Burden of Diseases, Injuries, and Risk Factors Study.

Fig. 4

The incidence burden of very EOCRC in 204 countries or regions. A: The ASR of incidence for very EOCRC in 2019. B: The AAPC of incidence for very EOCRC from 1990 to 2019. EOCRC: Early-onset colorectal cancer; ASR: Age-standardized rate; ASIR: Age-standard incidence rate; AAPC: Average annual percentage change.

Fig. 5

The deaths burden of very EOCRC in 204 countries or regions. A: The ASR of deaths for very EOCRC in 2019. B: The AAPC of deaths for very EOCRC from 1990 to 2019. EOCRC: Early-onset colorectal cancer; ASR: Age-standardized rate; ASMR: Age-standard mortality rate; AAPC: Average annual percentage change.

Fig. 6

The DALYs burden of very EOCRC in 204 countries or regions. A: The ASR of DALYs for very EOCRC in 2019. B: The AAPC of DALYs for very EOCRC from 1990 to 2019. DALYs: Disability-adjusted life years; EOCRC: Early-onset colorectal cancer; ASR: Age-standardized rate; AAPC: Average annual percentage change.

Fig. 7

Changes in very EOCRC incidence (A) and DALYs (B) burden attributed to three key factors (aging, population growth, and epidemiological changes) from 1990 to 2019 based on global level, SDI quintile and sex (decomposition analysis). The black dot stands for the overall change caused by all three key factors. As for each factor, a positive value signifies an increase in very EOCRC burden (incidence or DALYs), while a negative value indicates a decrease in very EOCRC burden (incidence or DALYs) contributed by the corresponding factor. EOCRC: Early-onset colorectal cancer; DALYs: Disability-adjusted life years; SDI: Sociodemographic Index.

Fig. 8

Frontier analysis based on SDI and ASR of DALYs for very EOCRC in 2019. The frontier was depicted in solid black color, while countries or regions were represented as dots. Red dots signified an increase in ASR of DALYs for very EOCRC from 1990 to 2019, while blue dots indicated a decrease over the same period. The top 15 countries or regions with the largest effective difference were labeled in black (Nauru, Guam, Seychelles, Philippines, Solomon Islands, Bahamas, American Samoa, Taiwan (Province of China), Micronesia (Federated States of), Kiribati, Brunei Darussalam, Northern Mariana Islands, Marshall Islands, Ukraine, and Azerbaijan). Countries or regions with low SDI (< 0.5) and a low effective difference were labeled in blue (Somalia, Nepal, Niger, Bangladesh, and Gambia), conversely, those countries or regions with high SDI (> 0.85) and relatively high effective difference were labeled in red (Taiwan (Province of China), Monaco, United States of America, Andorra, and San Marino). SDI: Sociodemographic Index; ASR: Age-standardized rate; DALYs: Disability-adjusted life years; EOCRC: Early-onset colorectal cancer.

Fig. 9

Percentage contribution of 10 risk factors to the deaths and DALYs burden of very EOCRC based on global level and 21 GBD regions in 2019. DALYs: Disability-adjusted life years; EOCRC: Early-onset colorectal cancer; GBD: Global Burden of Diseases, Injuries, and Risk Factors Study.