Global Trend and Cross-country Inequalities in the Burden of Colorectal Cancer Among Adults Aged 65 Years and Older, 1990–2021: A Systematic Analysis of the Global Burden of Disease Study 2021
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Background Colorectal cancer (CRC) is one of the leading causes of death among the elderly worldwide. Due to population aging, the burden of CRC among older adults is continuously increasing. However, the epidemiological characteristics, sex differences, and sociodemographic associations of colorectal cancer in adults aged 65 years and older have not been fully elucidated. Methods Leveraging data from the Global Burden of Disease 2021 study, we analyzed CRC burden trends—including incidence, mortality, and disability-adjusted life years (DALYs)—from 1990 to 2021 in individuals aged 65 and above. Temporal trends were assessed using the estimated annual percentage change. Health inequalities were evaluated using the slope index of inequality and the relative concentration index. Frontier analysis was employed to identify potential areas for reducing the CRC burden. Results In 2021, the number of newly diagnosed CRC cases among the elderly was approximately 2.5 times higher than in 1990, with deaths and DALYs roughly doubling over the same period. From 1990 to 2021, the global age-standardized incidence rate of CRC in adults aged 65 and older increased, while the age-standardized mortality and DALY rates declined. The CRC burden escalated with advancing age, and men experienced a higher burden compared to women. Health inequality analysis revealed that the disparity in DALY rates across different Socio-demographic Index (SDI) groups slightly narrowed by 2021 compared to 1990. Frontier analysis demonstrated an inverse correlation between the age-standardized DALY rate and the SDI. Conclusion This study highlights the increasing burden of CRC among adults aged 65 years and older. The findings provide a robust foundation for revising screening guidelines and implementing more effective, region-specific interventions to mitigate the CRC burden.
