Long-Term Shifts and Disparities in Colorectal Cancer Mortality in the United States: A Population-Based Analysis (1999–2023)

Background: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality in the United States despite advances in screening and treatment. Prior national studies have documented long-term declines in CRC mortality; however, emerging demographic and disparities warrant updated evaluation. Methods: We conducted a retrospective, population-based analysis of CRC mortality in the United States from 1999 to 2023 using the CDC WONDER database. Adults aged ≥25 years with CRC were identified using ICD-10 codes C18–C20. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Trends were assessed using Joinpoint regression. Results: From 1999 to 2023, a total of 1,551,550 CRC deaths were recorded among U.S. adults aged ≥25. The overall AAMR declined from 38.23 per 100,000 in 1999 to 22.93 in 2023 (AAPC: –2.14; 95% CI: –2.39 to –1.88; p < 0.001). Overall, the AAMR declined in both sexes between 1999 and 2023; 31.98 to 19.09 (AAPC: -2.16; p < 0.01) among women, as compared to 47.46 to 27.43 (AAPC: -2.31; p < 0.01) among men. Racial disparities persisted, with non-Hispanic Black individuals showing the highest overall AAMR (37.34). Regionally, the Midwest has the highest overall AAMR (30.05). Urban–rural comparisons (1999–2020) showed higher AAMRs in rural areas (32.08) than in metropolitan areas (27.81). Older adults (≥65 years) accounted for most deaths. The most common place of death was home (40.7%). Conclusions: CRC mortality in the U.S. has declined substantially over the past 25 years; however, significant disparities persist by race, geography, and age.