VANCOUVER, British Columbia—The incidence, prevalence and mortality associated with colorectal cancer all declined in the United States from 1990 to 2019, but the degree of decline was not evenly distributed by region or state, according to the Global Burden of Disease database.
The overall mortality reduction was 26%—from 20 per 100,000 to 14.8 per 100,000—but the greatest declines, averaging about 40%, occurred in northern states, such as Massachusetts, New York, and the District of Columbia, reported Saqr Alsakarneh, MD, a resident in internal medicine at the University of Missouri in Kansas City.
There was at least some decrease in mortality over the study period in every state except Mississippi, where the mortality of CRC increased over the study period by 1.5%, according to Dr. Alsakarneh, but he reported that modest reductions also were seen in numerous other southern states. He attributed the more modified CRC reductions in the south to higher rates of obesity, tobacco use and limited physical exercise.
In 1990, the age-standardized prevalence of CRC was 273 per 100,000 individuals, according to the data Dr. Alsakarneh derived from the GBD database and presented at the 2023 annual meeting of the American College of Gastroenterology (abstract P0199). In 2019, the prevalence was 259 per 100,000, a 5% overall decline from 1990. The incidence over the same time period fell from 47.6 per 100,000 to 41.0 per 100,000, a 12% decline.
Table. Prevalence and Incidence of CRC in 1990 and 2019
| Year | Prevalence/Incidence | Change |
| 1990 Prevalence | 273 per 100,000 | |
| 2019 Prevalence | 259 per 100,000 | 5% decline |
| 1900 Incidence | 47.6 per 100,000 | |
| 2019 Incidence | 41.0 per 100,000 | 12% decline |
Based on 2023 annual meeting of the American College of Gastroenterology (abstract P0199).
For all of these measures, the greatest declines were concentrated in northern states, even if they were shared to a lesser degree by states in other regions. For prevalence, the greatest declines in prevalence were observed in Massachusetts, Minnesota and Wisconsin. For incidence, the greatest declines were observed in Massachusetts, Minnesota and Rhode Island.
When analyzed by disability-adjusted life years (DALYs), females had slightly larger decreases than males during the study period (24.7% v. 23.8%).
It is reasonable to speculate that the positive trends are the product of earlier detection, probably through greater screening rates, and better therapies, Dr. Alsakarneh said. He pointed in particular to the contribution of endoscopy for both screening and resection.
The falling rates of CRC incidence, prevalence and mortality have been reported before. In an update on CRC epidemiology in the United States that was based on the Surveillance, Epidemiology and End Result database and published more than 7 years ago (Int J Mol Epidemiol Genet 2016;7[3]:105-114), a 50% decline in CRC mortality was reported over the years 1975 to 2012.
However, in the more recent state-by-state analysis, Dr. Alsakarneh found that the changes in CRC epidemiology within the United States differ markedly, emphasizing the potential for exploring regional differences in risk factors, frequency of screening, and perhaps treatment, to achieve further reductions in the third-most common cause of cancer death for men and women.
—Ted Bosworth
Dr. Alsakarneh reported no relevant financial disclosures.
