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RESEARCH PRODUCT

Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

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Correction to Lancet Gastroenterol Hepatol 2022; 7: 627-47. Lancet Gastroenterol Hepatol. 2022 Aug;7(8):704. doi: 10.1016/S2468-1253(22)00210-2. PMID: 35809605. Background: Colorectal cancer is the third leading cause of cancer deaths worldwide. Given the recent increasing trends in colorectal cancer incidence globally, up-to-date information on the colorectal cancer burden could guide screening, early detection, and treatment strategies, and help effectively allocate resources. We examined the temporal patterns of the global, regional, and national burden of colorectal cancer and its risk factors in 204 countries and territories across the past three decades. Methods: Estimates of incidence, mortality, and disability-adjusted life years (DALYs) for colorectal cancer were generated as a part of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019 by age, sex, and geographical location for the period 1990-2019. Mortality estimates were produced using the cause of death ensemble model. We also calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer. Findings: Globally, between 1990 and 2019, colorectal cancer incident cases more than doubled, from 842 098 (95% uncertainty interval [UI] 810 408-868 574) to 2·17 million (2·00-2·34), and deaths increased from 518 126 (493 682-537 877) to 1·09 million (1·02-1·15). The global age-standardised incidence rate increased from 22·2 (95% UI 21·3-23·0) per 100 000 to 26·7 (24·6-28·9) per 100 000, whereas the age-standardised mortality rate decreased from 14·3 (13·5-14·9) per 100 000 to 13·7 (12·6-14·5) per 100 000 and the age-standardised DALY rate decreased from 308·5 (294·7-320·7) per 100 000 to 295·5 (275·2-313·0) per 100 000 from 1990 through 2019. Taiwan (province of China; 62·0 [48·9-80·0] per 100 000), Monaco (60·7 [48·5-73·6] per 100 000), and Andorra (56·6 [42·8-71·9] per 100 000) had the highest age-standardised incidence rates, while Greenland (31·4 [26·0-37·1] per 100 000), Brunei (30·3 [26·6-34·1] per 100 000), and Hungary (28·6 [23·6-34·0] per 100 000) had the highest age-standardised mortality rates. From 1990 through 2019, a substantial rise in incidence rates was observed in younger adults (age <50 years), particularly in high Socio-demographic Index (SDI) countries. Globally, a diet low in milk (15·6%), smoking (13·3%), a diet low in calcium (12·9%), and alcohol use (9·9%) were the main contributors to colorectal cancer DALYs in 2019. Interpretation: The increase in incidence rates in people younger than 50 years requires vigilance from researchers, clinicians, and policy makers and a possible reconsideration of screening guidelines. The fast-rising burden in low SDI and middle SDI countries in Asia and Africa calls for colorectal cancer prevention approaches, greater awareness, and cost-effective screening and therapeutic options in these regions. This research was supported by funding from the Bill & Melinda Gates Foundation. J M Acuna acknowledges support from the Khalifa University College of Medicine and Health Sciences, Research and Data Intelligence Support Center, Khalifa University, Abu Dhabi, United Arab Emirates. S Ahmad thanks the Department of Health and Biological Sciences, Abasyn University, Peshawar, Pakistan, for their support. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait, for approval and support to participate in this research project. F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia, I.P. (FCT), in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; FCT/MCTES through the project UIDB/50006/2020. J Conde acknowledges the European Research Council Starting Grant (ERC-StG-2019-848325). V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. N Ghith acknowledges support by a grant from Novo Nordisk Foundation (NNF16OC0021856) in the form of salary payments. J C Glasbey is supported by a National Institute of Health Research (NIHR) Academy Doctoral Research Fellow (NIHR300175). V K Gupta and V B Gupta acknowledge funding support from the National Health and Medical Research Council (NHMRC), Australia. S Haque acknowledges support from the Jazan University, Jazan, Saudi Arabia, for providing the access of the Saudi Digital Library for this research study. A Pana, M Ausloos, and C Herteliu are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. M Jakovljevic acknowledges support from the Ministry of Education Science and Technological Development of the Republic of Serbia through the Grant OI175014 and from the Science Fund of The Republic of Serbia through Grant Em-CEAS. I Landires is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). B Li was supported by the Guangdong Philosophy and Social Science Fund (GD21YSH06), the Shenzhen Philosophy and Social Science Fund (grant number SZ2020C015), and the Shenzhen Science and Technology Fund (grant number 20200805164059001). J A Loureiro was supported by national funds through the Fundação para a Ciência e Tecnologia, under the Scientific Employment Stimulus (CEECINST/00049/2018). V Nuñez-Samudio is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). O O Odukoya acknowledges support from the Fogarty International Center of the National Institutes of Health under the award number K43TW010704. The content is solely the responsibility of the authors and does not necessarily represent the official views of the US National Institutes of Health. A M Samy acknowledges the support from the Egyptian Fulbright Mission Program. D A S Silva acknowledges support in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001 and in part by Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil (CNPq - 302028/2018-8) Sí