Analysis and prediction of colorectal cancer disease burden in middle-aged and elderly Chinese population from 1990 to 2021

Objective To analyze the current status and trends of colorectal cancer (CRC) burden among Chinese residents from 1990 to 2021, providing a basis for developing precise prevention and control strategies and measures. Methods Relevant data on CRC burden from the Global Burden of Disease database for China, Asia, and the world from 1990 to 2021 were collected. Descriptive analyses were conducted using indicators such as prevalence, mortality, and disability-adjusted life-years (DALY) rates. The age-period-cohort (APC) model was utilized to estimate the impacts of age, period, and cohort on CRC mortality, and the Bayesian APC model was employed to predict trends in CRC burden. Result: In 2021, China's age-standardized mortality, prevalence, and DALY rates for CRC were higher than those of both Asia and the world. From 1990 to 2021, the estimated annual percentage changes (EAPC) were -0.49%(95%CI: -0.55%~-0.43%), 3.17%(95%CI: 3.03%~3.31%), and -0.62% (95%CI: -0.71%~-0.54%), respectively. The standardized mortality and DALY rates for CRC in high and medium-high Socio-demographic Index (SDI) regions declined significantly but remained higher than other global regions. After controlling for cohort and period effects, CRC mortality increased with age in both Chinese, male, and female populations, with the increase being more pronounced among males. When controlling for age and cohort effects, with the 2002-2006 period group as the reference (RR=1), the period effect on female CRC mortality risk was higher than that of males and the total population before 2002-2006, thereafter showing a significant downward trend. After controlling for age and period effects, with the 1957 birth cohort as the reference (RR=1), the cohort effect on CRC mortality risk in Chinese, male, and female populations generally decreased with advancing birth cohorts. Projections indicate that by 2035, the standardized prevalence and mortality rates of CRC among Chinese residents will be 267.21 per 100, 000 and 12.29 per 100, 000, respectively. Conclusion From 1990 to 2021, China's age-standardized mortality and DALY rates for CRC showed an overall declining trend, while the standardized prevalence rate increased, suggesting that the government needs to continuously strengthen screening, deepen health education, optimize prevention and control strategies, and focus on implementing precise interventions targeting male and elderly high-risk groups to build a comprehensive, multi-level CRC prevention and control network.