Trends in colorectal cancer burden attributable to lifestyle in China (1990-2021): based on the global burden of disease study, revealing declining impact of dietary factors and rising influence of tobacco, alcohol, and obesity.

BACKGROUND

This study aimed to analyze trends in colorectal cancer (CRC) burden attributable to lifestyle factors in China (1990-2021), focusing on shifts of lifestyle, and to project future trajectories to inform public health strategies.

METHODS

Data from the Global Burden of Disease Study 2021 were utilized to assess deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) for CRC linked to nine lifestyle factors (including: diet low in whole grains, diet low in milk, diet low in fiber, diet low in calcium, diet high in red meat, diet high in processed meat, smoking, high alcohol use, and high BMI). Statistical analyses included estimated annual percentage change (EAPC), Joinpoint regression, age-period-cohort modeling, and Autoregressive Integrated Moving Average (ARIMA) projections (2022-2050).

RESULTS

Between 1990 and 2021, the burden of CRC attributable to most dietary factors declined, with significant reductions in low fiber (DALYs EAPC: -3.77) and low calcium intake (DALYs EAPC: -3.18). In contrast, processed meat intake showed an increase (DALYs EAPC: 1.64). Alcohol-related CRC burden rose slightly (DALYs EAPC: 0.35), while high BMI showed a marked increase (DALYs EAPC: 2.31). ARIMA projections suggest continued declines in dietary risk-related CRC burden. In contrast, the burden attributable to high body-mass index (BMI) is projected to rise substantially through 2050.

CONCLUSIONS

While improved dietary habits have reduced CRC burden in China, rising obesity pose growing threats. Public health policies must prioritize interventions targeting processed meat intake, and weight management to curb future CRC incidence and mortality.