Abstract
BACKGROUND: Colorectal cancer (CRC) is a leading gastrointestinal malignancy with rising incidence. Hyperglycemia emerges as a critical driver of CRC progression, yet its global disease burden, particularly regarding health inequality and years lived with disability (YLDs), remains underexplored. METHODS: This study leverages the Global Burden of Disease (GBD) 2021 dataset to analyze hyperglycemia-associated CRC burden across 21 regions and 204 countries from 1990 to 2021. It incorporates deaths, disability-adjusted life years (DALYs), YLDs, and years of life lost (YLLs), employing hierarchical clustering and health inequality metrics like the slope index of inequality and concentration index. Projections for 2022-2040 are generated using age-period-cohort models. RESULTS: Globally, age-standardized rates (ASRs) of deaths, YLDs, YLLs, and DALYs attributed to hyperglycemia-associated CRC showed upward trends from 1990 to 2021, with YLDs exhibiting the highest consistent increase (EAPC = 1.47, 95% UI:1.35-1.60). Significant health disparities persisted across the 30 years, with higher burdens concentrated in high-socio-demographic index (SDI) regions. Notably, while mortality-related burdens slightly decreased in high-SDI areas, YLDs continued to rise, indicating unmitigated disability burdens. Projections suggest stable death rates but increasing YLDs, DALYs, and YLLs through 2040. CONCLUSION: Hyperglycemia-associated CRC imposes an escalating global burden, marked by persistent health inequalities and rising long-term disabilities. Urgent strategies to enhance glycemic control, expand CRC screening, and address cross-national disparities are imperative to alleviate this burden.