Table_3_The global burden of colorectal cancer attributable to high body-mass index in 204 countries and territories: findings from 1990 to 2021 and predictions to 2035.XLSX

BackgroundThe association between high body-mass index (BMI) and colorectal cancer (CRC) has been confirmed and gained attention. However, a detailed understanding of the disease burden of high BMI and CRC remains lacking.
ObjectiveThis study aimed to assess the temporal and geographical trends of CRC deaths and disability-adjusted life years (DALYs) caused by high BMI globally from 1990 to 2021, providing effective guidance for developing prevention and treatment strategies.
MethodsWe used data from the 2021 Global Burden of Disease study to assess the global, regional, and national Deaths, DALYs, age-standardized mortality rate (ASMR), and age-standardized DALY rates (ASDR) caused by CRC related to high BMI, and further calculated the estimated annual percentage change (EAPC). We also considered factors such as gender, age, and sociodemographic index (SDI). We explore the relationship between EAPC and ASMR/ASDR (1990) and between EAPC and SDI (2021). Further, the autoregressive integrated moving average (ARIMA) model was applied to predict the disease burden from 2022 to 2035. The risk factors were calculated by Population Attributable Fraction (PAF).
ResultsIn 2021, CRC caused by high BMI resulted in 99,268 deaths (95% Uncertainty Interval (UI): 42,956–157,949) and 2,364,664 DALYs (95% UI: 1,021,594–3,752,340) globally, with ASMR and ASDR being 1.17 per 100,000 population (95% UI: 0.51–1.87) and 27.33 per 100,000 population (95% UI: 11.8–43.37), respectively. The disease burden was higher in males and the elderly, with significant differences between regions and sociodemographic groups. From 1990 to 2021, the ASMR for CRC associated with high BMI revealed little change globally, while the ASDR revealed an upward trend. The burden of CRC caused by high BMI has shifted from high SDI regions to low and low-middle SDI regions. Additionally, from 2022 to 2035, ASMR and ASDR are expected to increase in males, while ASMR and ASDR in females are expected to remain relatively stable.
ConclusionFrom 1990 to 2021, the number of deaths and DALYs related to high BMI-associated CRC globally, as well as ASMR and ASDR, continue to rise. We predict that ASMR and ASDR may further increase by 2035, making it crucial to take timely and targeted interventions.

背景 高体重指数（Body Mass Index, BMI）与结直肠癌（colorectal cancer, CRC）之间的关联已得到证实并受到广泛关注，但目前对高BMI相关结直肠癌的疾病负担仍缺乏深入认知。
目的 本研究旨在评估1990年至2021年全球范围内高BMI所致结直肠癌死亡病例数与伤残调整寿命年（disability-adjusted life years, DALYs）的时间与地理分布趋势，为制定防治策略提供有效参考依据。
方法 本研究采用2021年全球疾病负担（Global Burden of Disease, GBD）研究的数据，评估高BMI相关结直肠癌所致的全球、区域及国家层面的死亡病例数、伤残调整寿命年、年龄标化死亡率（age-standardized mortality rate, ASMR）与年龄标化伤残调整寿命年率（age-standardized DALY rates, ASDR），并进一步计算估计年度变化百分比（estimated annual percentage change, EAPC）。研究同时纳入性别、年龄及社会人口指数（sociodemographic index, SDI）等混杂因素，分析EAPC与1990年ASMR/ASDR、EAPC与2021年SDI之间的关联。此外，本研究采用自回归积分滑动平均（autoregressive integrated moving average, ARIMA）模型对2022年至2035年的疾病负担进行预测，并通过人群归因分数（Population Attributable Fraction, PAF）计算相关危险因素的归因占比。
结果 2021年，全球高BMI所致结直肠癌死亡病例达99268例（95%不确定区间（Uncertainty Interval, UI）：42956~157949），相关伤残调整寿命年为2364664人年（95% UI：1021594~3752340）；对应的年龄标化死亡率与年龄标化伤残调整寿命年率分别为1.17/10万（95% UI：0.51~1.87）与27.33/10万（95% UI：11.8~43.37）。该疾病负担在男性与老年人群中更高，且不同区域及社会人口指数分组间存在显著差异。1990年至2021年，全球高BMI相关结直肠癌的年龄标化死亡率基本保持稳定，而年龄标化伤残调整寿命年率呈上升趋势。高BMI相关结直肠癌的疾病负担已从高社会人口指数区域向低及中低社会人口指数区域转移。此外，预测显示2022年至2035年，男性的年龄标化死亡率与年龄标化伤残调整寿命年率将持续上升，而女性的对应指标将维持相对稳定。
结论 1990年至2021年，全球范围内高BMI相关结直肠癌的死亡病例数、伤残调整寿命年数及年龄标化死亡率、年龄标化伤残调整寿命年率均呈上升趋势。本研究预测，至2035年该指标仍可能进一步升高，因此及时采取针对性干预措施至关重要。