Published online Jan 15, 2024. doi: 10.4251/wjgo.v16.i1.182
Peer-review started: October 1, 2023
First decision: October 18, 2023
Revised: October 20, 2023
Accepted: December 11, 2023
Article in press: December 11, 2023
Published online: January 15, 2024
Currently, the research on the burden of colorectal cancer (CRC) mainly focuses on the trend analysis of incidence and mortality rates, with only a few in-depth studies on the disability-adjusted life years (DALYs) caused by risk factors, especially in the context of global aging and the lack of cooperation to achieve a community of shared future.
It is crucial to clarify the contribution of risk factors to the burden of CRC in developing countries with rapid aging rates toward enhancing regional cooperation, strengthening control of risk factors, and developing effective intervention measures for cancer screenings.
In this study, we employed DALYs in the Global Buden of Disease 2019 (GBD 2019) study to analyze the magnitude and variations of diet high in processed meat-induced CRC (DHPM-CRC) burden in different gender and age groups, as well as to explore the relevant evidence-based policies and interventions in the Belt and Road Initiative (“B and R”) countries so as to provide a reference for precision-coordinated prevention and control of CRC.
The absolute numbers and age-standardized mortality rates (ASMR) and age-standardized DALYs (ASDALR) for DHPM-CRC were calculated. For the estimated metrics, the 95% uncertainty interval was reported, which was calculated by extracting each number 1000 times from the posterior distributions by using the 2.5th and 97.5th order of the uncertainty distribution. ASMR and ASDALR were estimated using a global age structure in 2019 and divided by age into 5 groups: < 15 years, 15-49 years, 50-74 years, and ≥ 75 years. The regional data were stratified by social development index (SDI) (as high-, high-middle, middle-, low-middle, and low-), which is a composite indicator of a country’s lag-distributed income per capita, educational attainment, and the total fertility rate in women aged < 25 years. The methods of SDI development and computation are detailed elsewhere. The trends of DHPM-CRC’s burden from 1990 to 2019 were assessed by the join point regression software (version 4.9.0.0. March 2021) by using the 95% confidence intervals for the identified trend segment. In addition, we evaluated the average annual percent change (AAPC) of ASDALR for DHPM-CRC in gender and age. Meanwhile, we compared the changes in AAPC of burden in DHPM-CRC from 1990 to 2019 or from 2010 to 2019. The relationship between AAPC and increasing/decreasing trend or stability and the map visualization are detailed elsewhere. P < 0.05 was considered to indicate statistical significance.
The results indicated that: (1) The burden of DHPM-CRC in “B and R” countries in 2019 was positively correlated with the population size; (2) the “B and R” member countries in Central Europe not only exhibit high DALYs of DHPM-CRC but also a large increase in these rates; (3) there are gender differences in the ASR mortality and DALYs of DHPM-CRC in “B and R” countries; (4) there are age differences in the ASDALR of DHPM-CRC in countries along the “B and R” countries; and (5) differences were detected in the trend of DHPM-CRC burden between the Maritime Silk Route and the Land Silk Route along the “B and R” countries.
Unlike the general global studies, a quantitative and in-depth analysis focusing on the burden of DHPM-CRC helped clarify the impact of a single factor on the burden of CRC, and international organizations with strong links based on this factor are excellent samples for exploring the reduction of disease burden. We noted socioeconomic level, gender, and age differences in the burden of DHPM-CRC in “B and R” countries, thus making targeted cooperation in CRC prevention and control among “B and R” countries possible, especially considering the different development trends of disease burden among countries within the same organization to provide fresh perspectives on CRC prevention and control research.
In this study, we employed DALYs in the GBD 2019 to analyze the magnitude and variations of DHPM-CRC burden in the gender and age groups and explore the relevant evidence-based policies and interventions in the “B and R” countries so as to provide a reference for precision coordinated prevention and control of CRC.