Global, Regional, and National Burden of Colon and Rectum Cancer from 1990 to 2023, with Forecasts to 2050: A Systematic Analysis for the Global Burden of Disease Study 2023

Background: Colorectal cancer is a leading cause of cancer mortality and morbidity worldwide. To guide strategies for reducing disease burden, we analysed colorectal cancer incidence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2023 at global, regional, and national levels—including the impact of selected risk factors—and forecasted trends through 2050. <div> <br> </div> <div> Methods: Colorectal cancer estimates were generated using Global Burden of Disease Study (GBD) 2023 methods, employing data from vital registration systems, population-based cancer registries, and verbal autopsies. Mortality was estimated using ensemble models, and incidence using mortality-to-incidence ratios. Years of life lost (YLLs) were generated based on death counts and GBD standard life expectancy at the age of death, and years lived with disability (YLDs) by multiplying prevalence and disability weights. YLLs and YLDs were summed to yield DALYs. Decomposition analysis was used to estimate the contributions of population growth, population ageing, colorectal cancer risk factors, and changes in rates to temporal changes in colorectal cancer DALYs. For risk factors with evidentiary links to colorectal cancer, risk-attributable DALYs were estimated based on the GBD 2023 comparative risk assessment framework. Forecasts used GBD forecasting methods and were aligned with GBD 2023 estimates.&nbsp;&nbsp; </div> <div> <br> </div> <div> Findings: In 2023, colorectal cancer was the second-leading cause of cancer deaths (1.11 million [95% uncertainty interval, 0.997–1.21] deaths), with 2.31 million (2.03–2.58) incident cases, representing increases from 1990 of 90.4% (75.4–106.9) and 145.0% (114.3–183.1), respectively. Globally, 2023 rates of age-standardised incidence (ASIRs) and mortality (ASMRs) were 25.4 cases (22.2–28.3) and 12.3 deaths (11.0–13.4) per 100 000 population, respectively, with relatively stable global ASIR (percentage change: 3.2% [–9.5 to 18.3]) and a decrease of 21.9% (15.2–27.6) in ASMR between 1990 and 2023. In 2023, over three-fourths of global colorectal cancer cases and deaths occurred in World Bank high- and upper-middle income groups, which also experienced higher ASIRs than low- and lower-middle income groups. Notably, however, ASIRs increased between 1990 and 2023 for all groups except for high-income, where ASIR remained stable. ASMRs increased substantially in low- and lower-middle income groups, yet decreased in high- and upper-middle-income groups. In 2023, modifiable risk factors accounted for 55.7% (41.4–67.3) of the 26.2 million (23.8–28.6) global colorectal cancer DALYs, with dietary risks the leading contributor (37.2% [18.1–53.5]). Global DALYs increased by 76.4% (62.3–94.5) between 1990 and 2023, with population growth and ageing driving increases, partly offset by decreases related to risk-deleted DALY rates and risk factors. In 2050, global ASIRs and ASMRs are forecasted to be 24.6 (17.1–32.6) and 12.0 (8.9–16.4), respectively, per 100 000, while global incident cases and deaths are forecasted to rise to 4.21 million (2.76–5.81) and 2.21 million (1.50–3.20), respectively. </div> <div> <br> </div> <div> Interpretation: Colorectal cancer is a major global health concern, with rising numbers of cases and deaths globally. While most colorectal cancer cases and deaths occurred in high- and upper-middle income countries, ASIRs and ASMRs increased in lower-middle- and low-income countries. Over half of the disease burden is linked to modifiable risk factors, most notably dietary risks. Strengthening prevention, early detection, and access to care across the resource spectrum is essential to limit future burden. </div>