Zhang Xuyuan, Fan Haoyu, Han Sen, Zhang Ting, Sun Yanxia, Yang Liuyang, Li Wenliang
School of Clinical Medicine, Bengbu Medical University, Bengbu, 233030, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Oncology II, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
BMC Gastroenterol. 2025 May 2;25(1):332. doi: 10.1186/s12876-025-03948-2.
Colon and rectal cancers (CRCs) are among the most common malignancies worldwide. While previous studies have examined the disease burden and risk factors of CRC at regional levels, they lack the granularity needed for country-specific policy development. Using updated data from the Global Burden of Disease (GBD) 2021 study, this research explores the national-level spatial distribution of CRC burdens linked to key risk factors and analyzes temporal trends in their contributions. The findings aim to support the formulation of precise public health policies to effectively reduce CRC incidence.
Based on data from the GBD study 2021, we examined CRC-related incidence, prevalence, mortality, disability-adjusted life years (DALYs), and associated risk factors. Age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and DALY rate (ASDR) were obtained and analyzed from 1990 to 2021. We used regression analysis and stratification across the four World Bank regions to assess geographical variations and the effect of economic development levels. We further assessed the contribution of various risk factors to CRC-related deaths and DALYs, while analyzing the distribution and temporal trends of the top three contributing risk factors.
On a global scale, the ASDR for CRC declined from 357.33 per 100,000 in 1990 to 283.24 per 100,000 in 2021 (95% confidence interval [CI]: -0.82 to -0.64). In 2021, the regions classified by the World Bank as high income exhibited the highest ASDR in 2021, at 347.35 per 100,000, while the lower-middle-income regions reported the lowest ASDR, at 179.48 per 100,000. During this period, the global ASMR fell from 15.56 to 12.40 per 100,000, while the ASIR rose from 24.04 to 25.60 per 100,000. However, these trends were not consistent across different World Bank income regions. Key risk factors contributing to CRC included high red meat consumption, obesity, insufficient calcium intake, and alcohol consumption, with variations observed among the World Bank income groups.
Although the global burden of colorectal cancer (CRC) has declined from 1990 to 2021, particularly in high-income regions, the incidence rate continues to rise. The increase is more pronounced among individuals aged 50 years and older, who also bear a higher absolute incidence than younger populations. High red meat consumption, high body mass index (BMI), and low calcium intake remain the leading global risk factors for CRC. Effective weight management and the promotion of healthy lifestyles are essential strategies for reducing CRC risk across sexes, while smoking and alcohol control are particularly critical for alleviating the burden among males.
结直肠癌（CRC）是全球最常见的恶性肿瘤之一。尽管先前的研究已在区域层面探讨了结直肠癌的疾病负担和风险因素，但它们缺乏制定针对特定国家政策所需的详细程度。本研究利用《2021年全球疾病负担（GBD）》研究的最新数据，探索与关键风险因素相关的结直肠癌负担在国家层面的空间分布，并分析其贡献的时间趋势。研究结果旨在支持制定精确的公共卫生政策，以有效降低结直肠癌发病率。
基于《2021年全球疾病负担》研究的数据，我们研究了结直肠癌相关的发病率、患病率、死亡率、伤残调整生命年（DALYs）以及相关风险因素。获取并分析了1990年至2021年的年龄标准化发病率（ASIR）、年龄标准化死亡率（ASMR）和伤残调整生命年率（ASDR）。我们使用回归分析和世界银行四个区域的分层分析来评估地理差异和经济发展水平的影响。我们进一步评估了各种风险因素对结直肠癌相关死亡和伤残调整生命年的贡献，同时分析了前三大贡献风险因素的分布和时间趋势。
在全球范围内，结直肠癌的伤残调整生命年率从1990年的每10万人357.33降至2021年的每10万人283.24（95%置信区间[CI]：-0.82至-0.64）。2021年，世界银行分类为高收入的地区在2021年的伤残调整生命年率最高，为每10万人347.35，而中低收入地区报告的伤残调整生命年率最低，为每10万人179.48。在此期间，全球年龄标准化死亡率从每10万人15.56降至12.40，而年龄标准化发病率从每10万人24.04升至25.60。然而，这些趋势在不同的世界银行收入区域并不一致。导致结直肠癌的关键风险因素包括红肉高消费、肥胖、钙摄入不足和饮酒，在世界银行收入群体中存在差异。
尽管1990年至2021年期间全球结直肠癌负担有所下降，特别是在高收入地区，但发病率仍在继续上升。这种上升在50岁及以上的人群中更为明显，他们的绝对发病率也高于年轻人群。红肉高消费、高体重指数（BMI）和低钙摄入仍然是全球结直肠癌的主要风险因素。有效的体重管理和促进健康的生活方式是降低男女结直肠癌风险的重要策略，而控制吸烟和饮酒对减轻男性负担尤为关键。
