The global, regional, and national burden of colorectal cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
Authors: Saeid Safiri, Sadaf G Sepanlou, Kevin S Ikuta, Catherine Bisignano, Hamideh Salimzadeh, Alireza Delavari, Reza Ansari, Gholamreza Roshandel, Shahin Merat, Christina Fitzmaurice, Lisa M Force, Molly R Nixon, Hedayat Abbastabar, Kedir Hussein Abegaz, Mohsen Afarideh, Ayat Ahmadi, Muktar Beshir Ahmed, Tomi Akinyemiju, Fares Alahdab, Raghib Ali, Mahtab Alikhani, Vahid Alipour, Syed Mohamed Aljunid, Majid Abdulrahman Hamad Almadi, Amir Almasi-Hashiani, Rajaa M Al-Raddadi, Nelson Alvis-Guzman, Saeed Amini, Nahla Hamed Anber, Alireza Ansari-Moghaddam, Jalal Arabloo, Zohreh Arefi, Mohammad Asghari Jafarabadi, Abbas Azadmehr, Alaa Badawi, Nafiseh Baheiraei, Till Winfried Bärnighausen, Huda Basaleem, Masoud Behzadifar, Meysam Behzadifar, Yaschilal Muche Belayneh, Kidanemaryam Berhe, Krittika Bhattacharyya, Belete Biadgo, Ali Bijani, Antonio Biondi, Tone Bjørge, Antonio M Borzì, Cristina Bosetti, Ibrahim R. Bou-Orm, Hermann Brenner, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Giulia Carreras, Félix Carvalho, Carlos A Castañeda-Orjuela, Ester Cerin, Peggy Pei-Chia Chiang, Onyema Greg Chido-Amajuoyi, Ahmad Daryani, Dragos Virgil Davitoiu, Gebre Teklemariam Demoz, Rupak Desai, Mostafa Dianati nasab, Aziz Eftekhari, Iman El Sayed, Iffat Elbarazi, Mohammad Hassan Emamian, Aman Yesuf Endries, Firooz Esmaeilzadeh, Alireza Esteghamati, Arash Etemadi, Farshad Farzadfar, Eduarda Fernandes, João C Fernandes, Irina Filip, Florian Fischer, Masoud Foroutan, Mohamed M Gad, Silvano Gallus, Fatemeh Ghaseni-Kebria, Ahmad Ghashghaee, Giuseppe Gorini, Nima Hafezi-Nejad, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Susan Hasanpour-Heidari, Amir Hasanzadeh, Soheil Hassanipour, Simon I Hay, Chi Linh Hoang, Mihaela Hostiuc, Mowafa Househ, Olayinka Stephen Ilesanmi, Milena D. Ilic, Kaire Innos, Seyed Sina Naghibi Irvani, Farhad Islami, Anelisa Jaca, Nader Jafari Balalami, Nastaran Jafari delouei, Morteza Jafarinia, Mohammad Ali Jahani, Mihajlo Jakovljevic, Spencer L. James, Mehdi Javanbakht, Ensiyeh Jenabi, Ravi Prakash Jha, Farahnaz Joukar, Amir Kasaeian, Tesfaye Dessale Kassa, Mesfin Wudu Kassaw, Andre Pascal Kengne, Yousef Saleh Khader, Mojtaba Khaksarian, Rovshan Khalilov, Ejaz Ahmad Khan, Maryam Khayamzadeh, Maryam Khazaee-Pool, Salman Khazaei, Fatemeh Khosravi Shadmani, Jagdish Khubchandani, Daniel Kim, Adnan Kisa, Sezer Kisa, Jonathan M Kocarnik, Hamidreza Komaki, Jacek A Kopec, Ai Koyanagi, Ernst J. Kuipers, Vivek Kumar, Carlo La Vecchia, Faris Hasan Lami, Alan D Lopez, Platon D Lopukhov, Raimundas Lunevicius, Azeem Majeed, Maryam Majidinia, Amir Manafi, Navid Manafi, Ana-Laura Manda, Fariborz Mansour-Ghanaei, Lorenzo Giovanni Mantovani, Dhruv Mehta, Toni Meier, Hagazi Gebre Meles, Walter Mendoza, Tomislav Mestrovic, Bartosz Miazgowski, Tomasz Miazgowski, Seyed Mostafa Mir, Hamed Mirzaei, Karzan Abdulmuhsin Mohammad, Naser Mohammad Gholi Mezerji, Abdollah Mohammadian-Hafshejani, Milad Mohammadoo-Khorasani, Shafiu Mohammed, Farnam Mohebi, Ali H Mokdad, Lorenzo Monasta, Maryam Moossavi, Ghobad Moradi, Farhad Moradpour, Rahmatollah Moradzadeh, Azin Nahvijou, Gurudatta Naik, Farid Najafi, Javad Nazari, Ionut Negoi, Cuong Tat Nguyen, Trang Huyen Nguyen, Dina Nur Anggraini Ningrum, Felix Akpojene Ogbo, Andrew T Olagunju, Tinuke O Olagunju, Adrian Pana, David M. Pereira, Majid Pirestani, Akram Pourshams, Hossein Poustchi, Mostafa Qorbani, Mohammad Rabiee, Navid Rabiee, Amir Radfar, Marveh Rahmati, Fatemeh Rajati, David Laith Rawaf, Salman Rawaf, Robert C Reiner, Andre M N Renzaho, Nima Rezaei, Aziz Rezapour, Anas M Saad, Seyedmohammad Saadatagah, Basema Saddik, Farkhonde Salehi, Saleh Salehi Zahabi, Inbal Salz, Abdallah M Samy, Juan Sanabria, Milena M Santric Milicevic, Arash Sarveazad, Maheswar Satpathy, Ione J C Schneider, Mario Sekerija, Faramarz Shaahmadi, Hosein Shabaninejad, Morteza Shamsizadeh, Zeinab Sharafi, Mehdi Sharif, Amrollah Sharifi, Sara Sheikhbahaei, Reza Shirkoohi, Sudeep K Siddappa Malleshappa, Diego Augusto Santos Silva, Mekonnen Sisay, Catalin-Gabriel Smarandache, Moslem Soofi, Kjetil Soreide, Sergey Soshnikov, Vladimir I. Starodubov, Michelle L. Subart, Mark JM Sullman, Rafael Tabarés-Seisdedos, Amir Taherkhani, Berhe etsay Tesfay, Roman Topor-Madry, Eugenio Traini, Bach Xuan Tran, Khanh Bao Tran, Irfan Ullah, Olalekan A Uthman, Marco Vacante, Amir Vahedian-Azimi, Alessandro Valli, Elena Varavikova, Isidora S Vujcic, Ronny Westerman, Vahid Yazdi-Feyzabadi, Engida Yisma, Chuanhua Yu, Vesna Zadnik, Telma Zahirian Moghadam, Leila Zaki, Hamed Zandian, Zhi-Jiang Zhang, Christopher J L Murray, Mohsen Naghavi, Reza Malekzadeh
Journal: The Lancet. Gastroenterology & hepatology (2019)

BackgroundData about the global, regional, and country-specific variations in the levels and trends of colorectal cancer are required to understand the impact of this disease and the trends in its burden to help policy makers allocate resources. Here we provide a status report on the incidence, mortality, and disability caused by colorectal cancer in 195 countries and territories between 1990 and 2017.MethodsVital registration, sample vital registration, verbal autopsy, and cancer registry data were used to generate incidence, death, and disability-adjusted life-year (DALY) estimates of colorectal cancer at the global, regional, and national levels. We also determined the association between development levels and colorectal cancer age-standardised DALY rates, and calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer. All of the estimates are reported as counts and age-standardised rates per 100 000 person-years, with some estimates also presented by sex and 5-year age groups.FindingsIn 2017, there were 1·8 million (95% UI 1·8–1·9) incident cases of colorectal cancer globally, with an age-standardised incidence rate of 23·2 (22·7–23·7) per 100 000 person-years that increased by 9·5% (4·5–13·5) between 1990 and 2017. Globally, colorectal cancer accounted for 896 000 (876 300–915 700) deaths in 2017, with an age-standardised death rate of 11·5 (11·3–11·8) per 100 000 person-years, which decreased between 1990 and 2017 (−13·5% [–18·4 to −10·0]). Colorectal cancer was also responsible for 19·0 million (18·5–19·5) DALYs globally in 2017, with an age-standardised rate of 235·7 (229·7–242·0) DALYs per 100 000 person-years, which decreased between 1990 and 2017 (−14·5% [–20·4 to −10·3]). Slovakia, the Netherlands, and New Zealand had the highest age-standardised incidence rates in 2017. Greenland, Hungary, and Slovakia had the highest age-standardised death rates in 2017. Numbers of incident cases and deaths were higher among males than females up to the ages of 80–84 years, with the highest rates observed in the oldest age group (≥95 years) for both sexes in 2017. There was a non-linear association between the Socio-demographic Index and the Healthcare Access and Quality Index and age-standardised DALY rates. In 2017, the three largest contributors to DALYs at the global level, for both sexes, were diet low in calcium (20·5% [12·9–28·9]), alcohol use (15·2% [12·1–18·3]), and diet low in milk (14·3% [5·1–24·8]).InterpretationThere is substantial global variation in the burden of colorectal cancer. Although the overall colorectal cancer age-standardised death rate has been decreasing at the global level, the increasing age-standardised incidence rate in most countries poses a major public health challenge across the world. The results of this study could be useful for policy makers to carry out cost-effective interventions and to reduce exposure to modifiable risk factors, particularly in countries with high incidence or increasing burden.FundingBill & Melinda Gates Foundation.