Global, regional and national burden of colon and rectum cancer attributable to high fasting plasma glucose: a systematic analysis for the Global Burden of Disease Study 2021

TL;DR

High fasting blood sugar is linked to rising colorectal cancer deaths and disability worldwide, especially in high-income and urbanizing regions.

Contribution

First global analysis of CRC burden attributable to high fasting plasma glucose using GBD 2021 data across 204 countries.

Findings

High FPG-related CRC deaths increased from 31,907 in 1990 to 82,421 in 2021.

High SDI regions had the highest CRC burden from high FPG, while low-middle SDI regions saw the fastest rise.

Gender and socioeconomic disparities in CRC burden persisted despite declining relative inequalities.

Abstract

Colorectal cancer (CRC), the third most common malignant cancer globally, imposes a substantial public health burden. Emerging evidence has highlighted hyperglycemia as an independent risk factor for CRC. Estimates of the global burden of high fasting plasma glucose (FPG)-derived CRC are lacking.

We used the Global Burden of Disease (GBD) 2021 data to analyze deaths and disability-adjusted life years (DALYs) of CRC attributable to high FPG across 204 countries or territories. The GBD standard population was used to calculate age-standardized rates. Joinpoint regression identified temporal trends (1990–2021), and Bayesian age-period-cohort modeling projected future burdens (2022–2036). Health inequalities were assessed by stratifying the analyses according to the Sociodemographic Index (SDI).

Globally, high FPG-related CRC deaths increased from 31,907 (1990) to 82,421 (2021), with DALYs loss rising from 715,716 to 1,750,923. Age-standardized mortality rates (ASMR) and DALY rates (ASDR) increased by an average of 0.31% overall during the study period but declined post-2019. High SDI regions bore the highest burden (ASMR: 1.33 per 100,000 person-years; ASDR: 27.65 per 100,000 person-years), yet trends stabilized, whereas low-middle SDI regions saw the sharpest rise (ASMR average annual percentage change [AAPC]: 1.82%; ASDR AAPC: 1.77%). Males had a higher burden of CRC attributable to high FPG than females. Health inequality analysis showed that absolute differences in DALYs slightly increased (slope index of inequality of DALYs increased from 20.251 to 20.292), while relative differences decreased (concentration index of DALYs improvement: −0.344 to −0.294). Projections indicated a 6.1% decline in the ASMR and a 1.8% decrease in the ASDR by 2036.

The escalating burden of high FPG-driven CRC underscores its growing role in CRC epidemiology, particularly in aging populations and rapidly urbanizing regions. Persistent gender and socioeconomic disparities necessitate region-specific interventions that integrate diabetes management with CRC screening and equitable access to novel therapies. These findings advocate for prioritizing metabolic risk control in global CRC prevention frameworks to mitigate future burdens.

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