Evolving landscape of colorectal cancer: Global and regional burden, risk factor dynamics, and future scenarios (the Global Burden of Disease 1990-2050)

Abstract

Background: Presently, colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide. We provided global, regional, and national estimates of the burden of CRC and their attributable risks from 1990 to 2021, aiming to guide screening, early detection, and treatment strategies, optimize healthcare resource allocation, and facilitate the rational management of burden of CRC.

Methods: Using data derived from the Global Burden of Disease database, we estimated the incidence, mortality, and disability-adjusted life years (DALYs) of CRC. The temporal trends of the age-standardized rate of CRC were quantified by calculating the estimated annual percentage changes (EAPC). Deaths from CRC attributable to each risk factor that had evidence of causation with CRC were estimated. CRC's deaths and DALYs was forecast through 2050 by logistic regression with Socio-Demographic Index as a predictor, then multiplying by projected population estimates.

Results: Globally, between 1990 and 2021, the incident cases, death cases, and DALYs attributed to CRC have doubled, the age-standardized incidence rate (ASIR) presented a slightly upward tendency, while the age-standardized death rate (ASMR) and the age-standardized DALYs rate (ASDR) exhibited a decreasing trend. From 1990-2021, the ASIR for males has an increased trend, while females presented a downward trend. The ASIR and ASDR of CRC were higher in high and high-middle sociodemographic index (SDI) countries. The ASIR of CRC in 165 countries and territories showed escalating trend. Globally, for males and both sexes combined, diet low in whole grains was the leading risk factor for age-standardized deaths from CRC in 2021. However, among females, diet low in milk was the leading risk factor. We forecast that 2.18 million (1.53-2.94) individuals will death for CRC worldwide by 2050, and the DALYs achieve 41.7 million (29.9-55.4) by 2050.

Conclusion: The doubling of incidence counts and mortality cases and the rising ASIR in most countries indicates a significant burden of CRC. Authorities should devise suitable measures to address the increasing burdens, such as optimizing screening programs, enhancing awareness and screening efforts for males, and reducing exposure to modifiable risk factors.

Keywords: Colorectal cancer; Epidemiology; Global burden of disease.