Abstract
BACKGROUND: Colorectal cancer (CRC) remains a leading global malignancy with a rising obesity-attributable burden. Emerging evidence highlights concerning trends in early-onset CRC and marked regional disparities, underscoring the need for comprehensive epidemiological assessments to inform targeted prevention strategies. METHODS: Using Global Burden of Disease 2023 data, we analysed high body mass index (BMI)-related CRC deaths and disability-adjusted life years (DALYs) among adults (>40 years) from 1990-2023. We analysed both absolute counts and age-standardised rates, stratifying by sex, age, region, and sociodemographic index (SDI) categories. Decomposition analysis quantified the contributions of ageing, population growth, and epidemiological factors. We used Bayesian age-period-cohort analysis to project future trends. RESULTS: From 1990 to 2023, the global number of high BMI-related CRC deaths increased more than 2-fold, accompanied by a corresponding marked increase in DALYs. Western Europe had the highest burden, while South Asia had the most rapid growth in deaths, as measured by the estimated annual percentage change. Generally, as SDI decreased, the corresponding numbers of deaths and DALYs decreased. Cluster analysis based on the estimated annual percentage changes in age-standardised rates of high BMI-related CRC deaths and DALYs identified distinct regional patterns, with significant decreases in these rates in Western Europe and high-income North America, contrasted by significant increases in South Asia and Central Sub-Saharan Africa. Decomposition analysis indicated that population growth was the primary driver of the rise in mortality, followed by population ageing, and these were partially offset by improvements in epidemiological risk. Projections suggest a continuing increase in the age-standardised death rates for both males and females by 2038. CONCLUSIONS: High BMI has become a key driver of CRC mortality and incidence worldwide. Reducing this burden requires efforts in healthy lifestyles, policy reforms, and international scientific cooperation.