Early-onset colorectal cancer burden in China from 1990 to 2023: a systematic analysis based on the Global Burden of Disease Study 2023

Abstract

Early-onset colorectal cancer (EOCRC) impairs the health of China’s working-age population and causes substantial socioeconomic costs. National long-term epidemiological data integrating trend segmentation, risk attribution and medium-term forecasting for domestic EOCRC remain insufficient. This study analysed China’s 33-year EOCRC burden (1990-2023), identified trend inflection points, quantified modifiable risk-attributable burden and predicted epidemic trends to support tiered prevention strategies. Data on EOCRC burden among Chinese residents aged 15–49 were derived from the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We analyzed absolute cases and age-standardized rates of incidence, mortality, DALYs and prevalence. Joinpoint regression detected segmented nonlinear trends, and Autoregressive integrated moving average (ARIMA) models projected burden for 2024-2040. Dietary, metabolic and behavioural risk-attributable burden was quantified. From 1990 to 2023, national EOCRC mortality and DALY burden decreased continuously, whereas incident and prevalent cases increased significantly. Gender and age gradients existed: males and residents aged 45–49 carried the highest disease burden with slower improvement. Low milk and whole grain intake were the leading risk contributors, while high processed meat and high BMI showed rapidly rising attributable burden. All four burden indicators presented multi-stage trends and rebounded after 2020. ARIMA forecasts indicated age-standardized mortality and DALY rates would keep decreasing by 2040, yet male-dominated burden gaps remain prominent. China’s EOCRC presents divergent long-term burden trends and stable age-sex disparities. The high burden in the 45–49 age group supports prioritizing this population for further screening evaluation, and male-oriented lifestyle interventions may help curb growing incidence and alleviate youth colorectal cancer burden.