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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AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.