Comprehensive analysis of colorectal cancer burden in G20 countries from 1990 to 2023 and projections to 2030: findings from the Global Burden of Disease Study 2023.

INTRODUCTION: This study aimed to comprehensively assess the CRC burden in G20 countries from 1990 to 2023, analyze temporal trends by age and sex, quantify attributable risk factors, and project future burden to 2030. METHODS: Using data from the Global Burden of Disease Study 2023, we extracted incidence, mortality, and disability-adjusted life years (DALYs). Temporal trends were assessed using estimated annual percentage change (EAPC), factor attribution and Bayesian age-period-cohort (BAPC) models. RESULTS: From 1990 to 2023, incident CRC cases in G20 countries of age-standardized incidence rate (ASIR) showed a modest decline from 27.15 to 26.49 per 100,000 (EAPC: -0.27, 95% CI: -0.34 to -0.21). Peak burden shifted toward older age groups over three decades. Geographic heterogeneity was pronounced: rapidly industrializing countries showed dramatic increases, particularly South Korea (EAPC: 1.71) and Saudi Arabia (EAPC: 3.33). Risk factor attribution revealed dietary risks accounted for 40.0% of deaths and 39.0% of DALYs, followed by high fasting plasma glucose (8.0%), high body mass index (7.0%), low physical activity (7.0%), tobacco use (5.0%), and alcohol consumption (5.0%). BAPC projections indicated continued increases in ASIR from 31.86 per 100,000 in 2024 to 35.10 per 100,000 in 2030, with corresponding rises in mortality and DALY rates. CONCLUSIONS: Despite substantial declines in age-standardized mortality and DALY rates, absolute CRC burden in G20 countries has increased dramatically over three decades, driven by population growth and aging. Projected increases to 2030 necessitate strengthened primary prevention, expanded screening coverage.