This study leveraged long-term data on colorectal cancer incidence and mortality from 1994 to 2023 to quantify the effects of age, period, and birth cohort on both disease risk measures. It further estimated the temporal trajectories of disability-adjusted life years (DALYs) and mortality attributable to major risk factors, with the aim of identifying priority intervention nodes for current prevention and control strategies.

Data on colorectal cancer incidence and mortality in China from 1994 to 2023 were extracted from the Global Burden of Disease Study 2023 (GBD 2023) database. Case counts, death counts, crude rates, and age-standardized rates were compiled. For trend analysis, Joinpoint regression models were applied to estimate the annual percent change (APC) and average annual percent change (AAPC) to evaluate temporal dynamics in age-standardized rates. Additionally, age-period-cohort models were fitted to estimate the respective effects of age, period, and birth cohort on incidence and mortality risks. On this basis, changes in attributable mortality and DALYs due to major risk factors were quantified.

From 1994 to 2023, both the number of new cases and deaths from colorectal cancer in China showed an increasing trend. New cases rose from 213 800 to 611 400, and deaths increased from 149 100 to 257 500. Joinpoint regression results showed that the age-standardized incidence rate was on the rise (AAPC=0.75%, 95%CI: 0.44%~0.93%, P＜0.05), while the age-standardized mortality rate was declining (AAPC=−1.24%, 95%CI: −1.58%~−1.06%, P＜0.05). The age-period-cohort model indicated that both incidence and mortality risk increased with age. The period effect for incidence showed relatively small overall changes, while the period effect for mortality continued to decline. There were gender differences in the cohort effect on incidence, whereas the cohort effect on mortality generally showed a downward trend. Attributional burden results revealed that dietary factors and high fasting blood glucose remained important modifiable risk factors. The burden related to high BMI and excessive processed meat intake increased compared to 1994, and men consistently had higher attributional burdens related to behavioral and metabolic risks than women.

From 1994 to 2023, both the number of colorectal cancer cases and deaths in China have shown an upward trend. The age-standardized incidence rate has been rising, while the age-standardized mortality rate has been declining. The risk of getting sick and dying increases with age, so men and middle-aged to older adults should be prioritized for interventions. Improving diet, managing weight, and addressing metabolic issues can help ease the growing burden of colorectal cancer.