Temporal Trends in the Disease Burden of Colorectal Cancer with Its Risk Factors at the Global and National Level from 1990 to 2019, and Projections Until 2044

Figures & data

Table 1 The Incident Cases and ASIR in 1990 and 2019 and Its Temporal Trends

	1990		2019		1990–2019
	Incident Cases No. *10^3 (95% UI))	ASIR Per 100,000 No. (95% UI)	Incident Cases No. *10^3 (95% UI)	ASIR Per 100,000 No. (95% UI)	EAPC No. (95% CI)
Overall	842.1(810.41–868.57)	22.25(21.29–22.97)	2166.17(1996.3–2342.84)	26.71(24.58–28.89)	0.58(from 0.52 to 0.65)
Sex
Female	413.89(393.40–432.69)	19.92(18.83–20.81)	594.18(638.03–550.96)	21.22(19.05–23.16)	0.11(from 0.03 to 0.18)
Male	428.21(413.48–444.29)	25.19(24.24–26.11)	1239.73(1359.15–1133.17)	33.06(30.22–36.15)	0.95(from 0.87 to 1.02)
Socio-demographic index
High SDI	443.89(427.71–453.34)	42.45(40.91–43.35)	798.58(715.63–873.25)	42.78(38.75–46.64)	−0.17(from −0.28 to −0.06)
High middle SDI	237.9(229.79–246.09)	22.6(21.75–23.36)	655.82(594.86–716.67)	32.41(29.4–35.39)	1.29(from 1.19 to 1.4)
Middle SDI	104.83(97.28–113.06)	10.23(9.5–11.03)	465.98(418.6–515.36)	18.87(16.99–20.86)	2.61(from 2.44 to 2.77)
Low middle SDI	40.78(36.76–45.65)	6.88(6.23–7.71)	151.95(137.8–166.93)	11.27(10.23–12.35)	1.74(from 1.69 to 1.78)
Low SDI	14.28(11.96–16.83)	6.2(5.19–7.26)	36.95(32.89–41.03)	7.33(6.55–8.13)	0.81(from 0.69 to 0.93)
Region
Andean Latin America	2.02(1.8–2.24)	9.98(8.85–11.07)	11.09(8.93–13.47)	19.96(16.07–24.18)	2.7(from 2.52 to 2.88)
Australasia	12.03(11.52–12.42)	51.57(49.33–53.25)	23.67(19.44–28.85)	48.35(39.6–59.06)	−0.52(from −0.65 to −0.39)
Caribbean	4.69(4.49–4.85)	18.19(17.34–18.83)	13.81(11.81–15.96)	26.73(22.86–30.86)	1.43(from 1.37 to 1.49)
Central Asia	6.75(6.52–6.98)	13.99(13.51–14.46)	10.95(10–12.01)	15.21(13.93–16.61)	0.54(from 0.33 to 0.76)
Central Europe	41.59(40.37–42.59)	28.4(27.5–29.11)	84.47(74.55–95.45)	39.87(35.19–45.07)	1.23(from 1.11 to 1.35)
Central Latin America	7.48(7.2–7.66)	9(8.59–9.26)	37.54(32.21–43.87)	15.93(13.67–18.62)	1.92(from 1.83 to 2.02)
Central Sub-Saharan Africa	1.61(1.25–2.04)	7.42(5.91–9.27)	3.96(3.01–5.11)	7.68(5.92–10.07)	0.06(from −0.2 to 0.32)
East Asia	112.33(100.31–125.62)	12.77(11.44–14.26)	637.1(548.89–738.55)	30.94(26.75–35.72)	3.61(from 3.33 to 3.89)
Eastern Europe	70.4(68.29–72.72)	25.09(24.32–25.92)	106.02(96.25–117.07)	31.11(28.22–34.37)	0.56(from 0.4 to 0.73)
Eastern Sub-Saharan Africa	5.2(4.34–6.14)	7.01(5.83–8.25)	14.23(12.13–16.89)	8.83(7.64–10.37)	0.83(from 0.75 to 0.91)
High income Asia Pacific	77.18(73.96–79.22)	38.69(36.92–39.76)	196.37(166.42–225.64)	44.58(38.38–51.09)	0.35(from 0.23 to 0.47)
High income North America	167.9(160.79–172.26)	47.46(45.59–48.63)	260.91(229.91–295.69)	42.71(37.61–48.61)	−0.62(from −0.72 to −0.51)
North Africa and Middle East	15.43(12.97–18.18)	9.02(7.56–10.56)	60.01(53.35–67.56)	13.93(12.32–15.6)	1.71(from 1.5 to 1.91)
Oceania	0.25(0.19–0.3)	8.34(6.63–9.95)	0.69(0.56–0.86)	9.99(8.16–12.13)	0.55(from 0.49 to 0.62)
South Asia	29.94(26.44–34.06)	5.45(4.79–6.21)	113.71(98.19–129.35)	8.31(7.21–9.43)	1.31(from 1.18 to 1.44)
Southeast Asia	27.9(24.57–30.66)	10.81(9.6–11.81)	117.01(96.63–136.24)	19.3(15.97–22.4)	1.93(from 1.87 to 1.98)
Southern Latin America	10.93(10.52–11.26)	24.06(23.07–24.82)	26.87(21.48–33.61)	32.22(25.69–40.39)	0.94(from 0.83 to 1.05)
Southern Sub-Saharan Africa	2.87(2.5–3.34)	10.73(9.26–12.71)	7.11(6.39–7.88)	13.07(11.8–14.45)	0.7(from 0.53 to 0.88)
Tropical Latin America	10.72(10.34–11.05)	12(11.46–12.39)	42.89(40.12–44.93)	17.76(16.58–18.63)	1.44(from 1.23 to 1.65)
Western Europe	229.47(220.38–234.89)	39.57(38.03–40.47)	382.44(332.8–432.45)	42.42(37.09–48.26)	0.04(from −0.17 to 0.24)
Western Sub-Saharan Africa	5.43(4.4–6.64)	6.55(5.35–7.95)	15.32(12.89–17.82)	8.72(7.45–10.03)	1.21(from 1.1 to 1.32)

Figure 1 The distribution and trends of colorectal cancer incidence globally. (A) Global number of incident cases and incidence rate of colorectal cancer per 100000 person-years by age and sex, 2019 (B) The ASIR in global, SDI regions, and 21 GBD regions by sex (C) The percentage change in ASIR of colorectal cancer for global and SDI regions by age from 1990 to 2019 (D) The EAPC of colorectal cancer ASIR in global, SDI regions, and 21 GBD regions by sex.

Abbreviations: ASIR, age-standardized incidence rate; EAPC, estimated annual percentage change.

Figure 2 The trend in ASIR (A) and ASDR (B) of colorectal cancer across 21 GBD regions and global by SDI for both sexes combined, 1990–2019. For each region, points from left to right depict estimates from each year from 1990 to 2019.

Abbreviations: GBD, Global Burden of Diseases, Injuries, and Risk Factors Study; SDI, Socio-demographic Index; ASIR, age-standardized incidence rate; ASDR, age-standardized death rate.

Figure 3 The global disease burden of colorectal cancer for both genders in 204 countries and territories. (A) The EAPC of Colorectal cancer ASIR from 1990 to 2019 (B) The EAPC of Colorectal cancer ASDR from 1990 to 2019 (C) The EAPC of Colorectal cancer age-standardized DALY rate from 1990 to 2019.

Abbreviations: ASIR, ASDR age-standardized incidence/death; EAPC, estimated annual percentage change; SDI, socio-demographic index.

Table 2 The Death Cases and ASDR in 1990 and 2019 and Its Temporal Trends

	1990		2019		1990–2019
	Death Cases No. *10^3 (95% UI))	ASDR Per 100,000 No. (95% UI)	Death Cases No. *10^3 (95% UI)	ASDR Per 100,000 No. (95% UI)	EAPC No. (95% CI)
Overall	518.13(493.68–537.88)	14.31(13.52–14.88)	1085.8(1002.8–1149.68)	13.69(12.6–14.51)	−0.21(from −0.28 to −0.14)
Sex
Female	260.82(244.56–275.30)	12.91(12.03–13.64)	926.43(1011.63–831.86)	11.24(10.01–12.17)	−0.59(from −0.67 to −0.52)
Male	257.31(246.26–271.01)	16.16(15.44–16.93)	13,959.59(15,045.72–12,895.72)	16.64(15.39–17.85)	0.1(from 0.03 to 0.17)
Socio-demographic index
High SDI	222.3(211.3–228.21)	21.18(20.08–21.75)	327.57(294.9–345.58)	16.29(14.93–17.09)	−1.09(from −1.17 to −1)
High middle SDI	162.69(155.45–168.79)	16.08(15.28–16.7)	326.64(299.66–349.53)	16.24(14.9–17.39)	−0.04(from −0.15 to 0.06)
Middle SDI	83.37(76.84–90.07)	8.77(8.1–9.44)	279.78(251.15–306.14)	11.98(10.76–13.09)	1.24(from 1.1 to 1.37)
Low middle SDI	36.05(32.66–40.41)	6.5(5.87–7.28)	116.55(105.51–128.33)	9.08(8.22–9.94)	1.15(from 1.11 to 1.19)
Low SDI	13.44(11.31–15.79)	6.22(5.21–7.26)	34.66(30.96–38.61)	7.33(6.53–8.14)	0.58(from 0.52 to 0.64)
Region
Andean Latin America	1.52(1.35–1.69)	7.88(6.97–8.77)	5.63(4.59–6.79)	10.32(8.41–12.43)	1.16(from 1.02 to 1.3)
Australasia	5.64(5.38–5.81)	24.41(23.19–25.2)	8.38(7.57–8.98)	16.24(14.82–17.29)	−1.73(from −1.88 to −1.59)
Caribbean	3.29(3.11–3.42)	13.13(12.36–13.65)	7.99(6.94–9.18)	15.46(13.41–17.75)	0.63(from 0.57 to 0.68)
Central Asia	5.12(4.95–5.3)	10.96(10.57–11.34)	7.47(6.82–8.17)	11.21(10.27–12.22)	0.33(from 0.17 to 0.5)
Central Europe	30.83(29.77–31.6)	21.53(20.69–22.11)	51.57(45.64–57.75)	23.57(20.8–26.42)	0.32(from 0.21 to 0.42)
Central Latin America	5.73(5.48–5.89)	7.3(6.9–7.54)	22.47(19.54–26)	9.71(8.42–11.22)	0.97(from 0.93 to 1.01)
Central Sub-Saharan Africa	1.52(1.21–1.9)	7.55(6.05–9.42)	3.54(2.7–4.61)	7.45(5.74–9.87)	−0.11(from −0.36 to 0.14)
East Asia	83.31(73.75–93.32)	10.28(9.16–11.43)	275.6(238.24–317.89)	14.1(12.24–16.15)	1.4(from 1.17 to 1.64)
Eastern Europe	49.83(48.38–51.35)	18.01(17.45–18.57)	63.48(57.18–70.01)	18.3(16.47–20.2)	−0.31(from −0.51 to −0.12)
Eastern Sub-Saharan Africa	4.9(4.1–5.79)	7.04(5.87–8.24)	12.72(10.94–15)	8.47(7.38–9.9)	0.69(from 0.62 to 0.76)
High income Asia Pacific	34.34(32.6–35.18)	17.94(16.9–18.45)	76.93(64.82–83.6)	15.29(13.42–16.36)	−0.68(from −0.75 to −0.62)
High income North America	71.91(67.82–74.17)	20.01(18.91–20.61)	95.66(88.32–99.69)	14.94(13.94–15.51)	−1.22(from −1.32 to −1.13)
North Africa and Middle East	13.08(11.01–15.35)	8.2(6.87–9.56)	39.15(34.76–44.11)	9.83(8.68–11.05)	0.81(from 0.62 to 1)
Oceania	0.21(0.16–0.25)	7.74(6.1–9.24)	0.55(0.44–0.68)	8.81(7.19–10.65)	0.41(from 0.34 to 0.49)
South Asia	27.31(24.14–31.14)	5.34(4.66–6.1)	94.85(81.52–109.07)	7.29(6.25–8.33)	0.91(from 0.79 to 1.04)
Southeast Asia	23.64(20.96–25.97)	9.82(8.72–10.73)	82.02(67.62–94.61)	14.4(11.89–16.62)	1.25(from 1.19 to 1.31)
Southern Latin America	8.83(8.47–9.09)	19.95(18.99–20.6)	17.93(16.77–18.97)	21.22(19.87–22.44)	0.15(from 0.05 to 0.25)
Southern Sub-Saharan Africa	2.57(2.21–3.04)	10.17(8.66–12.21)	5.92(5.33–6.58)	11.52(10.4–12.74)	0.45(from 0.24 to 0.66)
Tropical Latin America	8.47(8.12–8.75)	10.1(9.57–10.47)	27.7(25.67–29.09)	11.68(10.78–12.28)	0.6(from 0.44 to 0.75)
Western Europe	130.91(124.43–134.4)	22.24(21.14–22.83)	172.45(155.34–181.81)	17.32(15.83–18.13)	−1.09(from −1.25 to −0.92)
Western Sub-Saharan Africa	5.19(4.25–6.33)	6.61(5.44–7.98)	13.77(11.7–16.07)	8.41(7.27–9.67)	1.05(from 0.95 to 1.15)

Figure 4 The distribution and trends of colorectal cancer death globally. (A) Global number of deaths and death rate of colorectal cancer per 100000 person-years by age and sex, 2019 (B) The ASDR in global, SDI regions, and 21 GBD regions by sex (C) The percentage change in ASDR of colorectal cancer for global and SDI regions by age from 1990 to 2019 (D) The EAPC of colorectal cancer ASDR in global, SDI regions, and 21 GBD regions by sex.

Abbreviations: ASDR, age-standardized death rate; EAPC, estimated annual percentage change; GBD: Global Burden of Diseases.

Table 3 The DALY and Age-Standardized DALY Rate in 1990 and 2019 and Its Temporal Trends

	1990		2019		1990–2019
	DALY No. *10^3 (95% UI))	Age-Standardized DALY Rate Per 100,000	DALY No. *10^3 (95% UI)	Age-Standardized DALY Rate Per 100,000	EAPC No. (95% CI)
Overall	12,408.15(11,858.13–12,924.93)	308.51(294.71–320.75)	24,284.09(22,614.92–25,723.22)	295.54(275.17–312.98)	−0.21(from −0.26 to −0.15)
Sex
Female	5934.54(5614.69–6295.86)	276.8(261.99–293.17)	10,324.5(11,149.97–9494.91)	237.93(218.73–257.07)	−0.65(from −0.71 to −0.6)
Male	6473.61(6165.74–6879.92)	346.63(330.92–366.69)	13,959.59(12,895.72–15,045.72)	360.05(333.07–387.83)	0.13(from 0.06 to 0.2)
Socio-demographic index
High SDI	4660.35(4514.65–4766.63)	454.74(441.07–465.07)	6164.66(5754.65–6435.9)	347.31(328.16–361.58)	−1.11(from −1.17 to −1.04)
High middle SDI	3960.5(3798.2–4115.13)	364.37(349.2–378.43)	7174.86(6649.07–7693.26)	356.65(330.6–382.58)	−0.18(from −0.28 to −0.08)
Middle SDI	2365.88(2176.49–2557.3)	208.23(191.81–224.72)	6990.43(6308.9–7671.29)	273.61(247.05–299.9)	1.11(from 0.99 to 1.24)
Low middle SDI	1034.04(932.27–1157.75)	155.87(141.29–174.79)	2998.33(2703.93–3314.97)	209.51(189.36–231.12)	1.01(from 0.98 to 1.05)
Low SDI	381.06(318.7–450.05)	146.24(122.95–172.24)	942.42(835.79–1059.27)	166.1(148.36–185.88)	0.44(from 0.38 to 0.5)
Region
Andean Latin America	38.03(33.89–42.37)	173.85(154.26–193.62)	125.58(101.75–151.8)	220.77(179.05–266.3)	1.04(from 0.89 to 1.18)
Australasia	126.15(121.96–129.71)	546.86(528.38–562.22)	163.25(150.87–173.96)	348.6(324.22–370.74)	−1.89(from −2.03 to −1.74)
Caribbean	75.93(72.04–78.98)	285.84(271.18–297.27)	172.02(147.19–200.17)	333.31(285.19–387.92)	0.6(from 0.54 to 0.66)
Central Asia	147.81(143.12–153.24)	292.76(283.38–303.21)	199.84(182.01–219.94)	256.81(234.43–281.07)	−0.37(from −0.53 to −0.21)
Central Europe	716.52(699.25–732.01)	486.32(474.11–497.21)	1052.15(922.92–1184.25)	512.56(448.72–577.87)	0.17(from 0.07 to 0.27)
Central Latin America	148.16(144.01–151.43)	162.28(156.79–166.15)	539.64(465.2–627.07)	223.68(193.13–259.51)	1.11(from 1.07 to 1.15)
Central Sub-Saharan Africa	43.59(34.56–54.9)	173.85(138.79–217.27)	100.99(75.75–131.45)	169.27(129.19–220.17)	−0.14(from −0.38 to 0.1)
East Asia	2385.46(2099.38–2681.23)	248.57(219.64–278.37)	6712.86(5774.28–7735.91)	325.17(280.71–373.18)	1.24(from 1.02 to 1.46)
Eastern Europe	1231.36(1191.18–1269.24)	438.41(423.82–452.11)	1419.1(1287.54–1571.37)	423.7(384–469.26)	−0.57(from −0.79 to −0.34)
Eastern Sub-Saharan Africa	140.16(116.32–167.14)	167.23(139.86–198.34)	356.43(301.93–425.61)	193.87(165.98–229.61)	0.54(from 0.47 to 0.62)
High income Asia Pacific	806.45(779.64–825.25)	398.32(383.37–408.3)	1327.82(1186.12–1414.81)	323.88(298.56–342.11)	−0.88(from −0.96 to −0.8)
High income North America	1508.39(1456.32–1550.41)	440.58(426.18–452.35)	1987.11(1895.87–2059.77)	339.86(325.95–351.88)	−1.07(from −1.16 to −0.97)
North Africa and Middle East	365.14(308.29–432.79)	192.83(162.72–227.03)	1013.63(896.16–1146.53)	218.67(194.05–246.53)	0.56(from 0.38 to 0.74)
Oceania	6.2(4.86–7.52)	182.18(142.63–218.44)	16.31(12.92–20.56)	203.57(163.6–252.47)	0.36(from 0.3 to 0.42)
South Asia	786.71(697.21–893.7)	125.38(111.12–142.89)	2419.1(2078.02–2782.57)	165.06(141.74–189.86)	0.8(from 0.68 to 0.92)
Southeast Asia	672.88(590.9–746.28)	235.88(208.45–260.09)	2142.43(1780.49–2482.29)	333.97(276.63–386.37)	1.12(from 1.05 to 1.18)
Southern Latin America	195.3(189.16–200.64)	422.05(407.73–433.74)	366.44(347.73–385.44)	447.56(424.73–470.53)	0.17(from 0.09 to 0.24)
Southern Sub-Saharan Africa	65.68(58–75.1)	222.51(193.9–259.8)	147.78(132.44–165.54)	250.43(225.14–279.33)	0.49(from 0.28 to 0.7)
Tropical Latin America	222.1(215.29–228.25)	226.7(218.3–233.65)	660.13(625.56–687.74)	268.3(253.73–279.78)	0.68(from 0.51 to 0.85)
Western Europe	2593.19(2510.12–2651.07)	461.93(448.21–471.78)	3008.23(2815.06–3152.89)	351.25(332–366.8)	−1.17(from −1.3 to −1.03)
Western Sub-Saharan Africa	132.93(106.96–162.8)	143.84(117.11–175.65)	353.24(295.57–420.7)	176.11(149.04–206.17)	0.88(from 0.79 to 0.97)

Figure 5 The observed (dashed line) and predicted (solid line) cases (A) and deaths (B) of colorectal cancer from 1990 to 2044. The upper bound of Shading represents the rate increased by 1% per year (pessimistic reference) and the lower bound represents decreased by 1% per year (optimistic reference) based on the rate observed in 2019.

Figure 6 Percentage of attributable to risk factors of colorectal cancer in different year or gender. (A) deaths attributable to risk factors between 1990 and 2019 (B) deaths attributable to risk factors between 1990 and 2019 (C) deaths attributable to risk factors between different gender in 2019 (D) deaths attributable to risk factors between different gender in 2019.