Global, regional, and national burden of early-onset and late-onset colorectal cancer, 1990–2021: a comparative analysis for the Global Burden of Disease Study 2021

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Early-onset colorectal cancer (EOCRC) shows a rising global incidence with distinct epidemiological features from late-onset colorectal cancer (LOCRC). This study aimed to compare the epidemiological patterns and temporal trends of EOCRC and LOCRC from 1990 to 2021 based on the Global Burden of Disease (GBD) 2021 dataset. We analyzed the incidence, prevalence, mortality, and DALYs of EOCRC and LOCRC across 204 countries using the GBD 2021 dataset. Age-standardized rates (ASRs), estimated annual percentage changes (EAPCs), and socio-demographic index (SDI) stratifications were applied. Projections to 2040 were performed using Bayesian modeling. In 2021, LOCRC remained dominant (1.98 million vs. 212,000 cases), but EOCRC exhibited a faster incidence increase (EAPC: 0.37 vs. 0.13). Males were predominant, particularly in cases of EOCRC. Higher SDI was generally associated with higher incidence, though LOCRC declined in regions with SDI >0.85. The rise in EOCRC burden was primarily driven by aging, while population growth drove LOCRC. Projections indicate that ASRs of EOCRC will peak then decrease, whereas LOCRC will continue to rise. LOCRC remains dominant globally, but the rapid increase in EOCRC requires urgent public health action. Age-specific strategies are needed: optimized screening for the elderly to control LOCRC and strengthened risk factor management in young populations to reduce EOCRC. This study provides the first comprehensive evaluation of the global burden and spatiotemporal evolution of early-onset (EOCRC) and late-onset colorectal cancer (LOCRC) from 1990 to 2021.LOCRC remains the dominant subtype with a substantially higher incidence and prevalence than EOCRC, whereas EOCRC shows a faster increasing incidence but also greater temporal improvement.Gender disparities are more prominent in the EOCRC group than in the LOCRC group, with distinct epidemiological patterns observed between male and female populations.EOCRC incidence increases with increasing socio-demographic index (SDI), whereas LOCRC incidence declines in regions with SDI > 0.85, revealing unique SDI-related patterns for each subtype.Population aging is the main driver of the rising EOCRC burden, whereas population growth predominantly contributes to the increasing burden of LOCRC. This study provides the first comprehensive evaluation of the global burden and spatiotemporal evolution of early-onset (EOCRC) and late-onset colorectal cancer (LOCRC) from 1990 to 2021. LOCRC remains the dominant subtype with a substantially higher incidence and prevalence than EOCRC, whereas EOCRC shows a faster increasing incidence but also greater temporal improvement. Gender disparities are more prominent in the EOCRC group than in the LOCRC group, with distinct epidemiological patterns observed between male and female populations. EOCRC incidence increases with increasing socio-demographic index (SDI), whereas LOCRC incidence declines in regions with SDI > 0.85, revealing unique SDI-related patterns for each subtype. Population aging is the main driver of the rising EOCRC burden, whereas population growth predominantly contributes to the increasing burden of LOCRC. Colorectal cancer (CRC) is highly heterogeneous between early-onset CRC (EOCRC) and late-onset CRC (LOCRC), with distinct clinical features and significant prognostic differences. We analyzed global health data from 1990 to 2021 to compare the disease burden of these two groups across different countries and regions based on the Global Burden of Disease (GBD) 2021 dataset. Our study found that LOCRC remains more common overall, while early-onset cases have been increasing more rapidly. Men were at a higher risk of EOCRC than women, and these patterns differed by region and social development level. Population aging mainly drove the rising burden of EOCRC, whereas population growth contributed more to LOCRC. These findings can help improve public health strategies, screening guidelines, and targeted interventions to better prevent and control CRC worldwide.

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