To analyze the long-term change trend of colorectal mortality in China from 1990 to 2021, and to provide scientific recommendations for the prevention and control of colorectal cancer in China.

The mortality burden data of colorectal cancer in China from 1990 to 2021 were obtained from GBD2021. The trend of mortality was analyzed by Joinpoint regression model, Using age-period-queue model assessment age, period and cohort effects.

From 1990 to 2021, the overall colorectal population and the standardized mortality rate of females in China showed a downward trend, while that of males showed an upward trend, and the change rates were -11.94%, 2.10% and -29.40%, respectively. APC model analysis showed that from 1990 to 2021, the colorectal age mortality rate in China increased with the increase of age, from 0.51/100 000 to 224.02/100 000 for the total population, from 0.48/100 000 to 525.14/100 000 for males, and from 0.62/100 000 to 107.38/100 000 for females. The period effect showed an overall downward trend, with the risk of death decreasing from 1.17 in 1992 to 0.96 in 2021 in the general population, from 1.03 to 1.00 in men, and from 1.42 to 0.89 in women. All the cohort effects showed a decreasing trend. The risk of death in the general population decreased from 1.42 in the 1897~1904 birth cohort to 0.48 in the 1997~2006 birth cohort, from 1.03 to 0.67 in men, and from 2.20 to 0.25 in women. It is important to note that APC models show a slow upward trend in mortality risk between about 2011 and 2021.

From 1990 to 2021, the total population and the death burden of females decreased, while the death burden of males increased. However, in recent years, the death burden of colorectal cancer in Chinese population of different genders showed a slow upward trend, suggesting that the death burden is still severe. More attention should be paid to middle-aged and elderly males, to reduce the mortality burden of colorectal cancer, effective intervention measures should be strengthened in the high-risk population.