Temporal Shifts in the Age-Specific Burden and Risk Factors of Colorectal Cancer in China, 1990–2021

Objective To analyze the long-term trends, age- and sex-specific patterns, and attributable risk factors of the colorectal cancer (CRC) burden in the Chinese population aged ≥ 60 years from 1990 to 2021, so as to provide a scientific basis for targeted prevention and control in this aging population. Methods Data on the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of CRC in China from 1990 to 2021 were extracted from the Global Burden of Disease (GBD) 2021 database, along with corresponding age-standardized rates. Temporal trends were analyzed using Joinpoint regression, and risk factors were assessed via population attributable fraction (PAF), with stratified comparisons by age and sex. Results From 1990 to 2021, the age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of CRC in China increased by 65.13% and 141.23%, respectively, while the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) decreased by 11.94% and 15.08%, respectively. The average annual percentage changes (AAPCs) were as follows: ASIR 1.67%, ASPR 2.95%, ASMR − 0.45%, and ASDR − 0.54%. In 2021, metabolic risk factors (high BMI and high fasting plasma glucose) showed the largest increase in PAF (up 5.4% since 1990) in the 60–74 age group, with high BMI alone accounting for a PAF of 7.7%. The combined PAF for smoking and alcohol use was 19.2% in men versus only 2.0% in women, indicating substantial sex-based disparities in behavioral risks. Dietary factors remained the leading risk category, though their composition shifted: excessive red meat consumption accounted for a PAF of 16.0%, while inadequate calcium intake contributed 7.1–8.1%, with no marked sex differences. Conclusion From 1990 to 2021, men aged 60–74 bore the heaviest burden of CRC in China, driven collectively by metabolic factors (high BMI, high blood glucose), behavioral factors (smoking, alcohol use), and dietary factors (excessive red meat intake). This demographic should be prioritized for CRC screening and benefit from integrated interventions such as chronic disease management, smoking and alcohol cessation, and dietary modifications.