Disease burden and projection of total and early-onset colorectal cancer in Gulf cooperation council countries from 1990 to 2019

Abstract

Background

Early-onset colorectal cancer (EO-CRC) incidence and prevalence trends in the rise in high income countries, such as the Gulf Cooperation Council (GCC) countries. The study aimed to offer an up-to-date assessment of the overall burden of CRC, and EO-CRC in GCC countries and project its incidence and mortality in 2030.

Method

The prevalence, incidence, mortality, years of life lived with disability (YLDs), and disability-adjusted life years (DALYs) of CRC were obtained from the Global Burden of Disease (GBD) Study 2019. The incidence and mortality of CRC, and EO-CRC up to 2030 were predicted.

Results

All GCC countries showed a higher annual average percentage changes (AAPC) AAPC incidence rate for EO-CRC compared to CRC. In Saudi Arabia the number of CRC cases has increased from 1990 1484.57; (95 % UI 1987.98,1083.86) 11.4-fold-increase to 16991.83; (95 % UI 21754.79,12892.12) in 2019. In 2030, the total incidence cases of CRC for the six Gulf countries are expected to reach 13,339 thousand, primarily driven by Saudi Arabia with 7,910.19 cases. In 2030, the CRC mortality rate is projected to be 7,647 cases, with nearly 57 % of CRC mortality cases anticipated in Saudi Arabia.

Conclusion

This study sheds light on the alarming rise in CRC and EO-CRC across Gulf countries from 1990 to 2019, emphasizing Saudi Arabia's significant burden. It projects a concerning increase in CRC incidence and mortality by 2030, primarily in Saudi Arabia, and highlights the need for immediate public health interventions.

Introduction

The global incidence and mortality rates of colorectal cancer (CRC) are experiencing a rapid and alarming increase. CRC is on track to become the third most prevalent cancer type and the second primary cause of cancer-related fatalities [1]. In 2020, it is estimated that there were more than 1.9 million newly diagnosed cases of CRC and nearly one million deaths attributed to the disease, accounting for approximately one-tenth of all cancer cases and related fatalities [1]. Furthermore, concerning trends in the occurrence and prevalence of early-onset colorectal cancer (EO-CRC) have been observed, particularly in regions characterized by a high-middle Socio-demographic Index (SDI), including the Gulf Cooperation Council (GCC) member nations [2], [3], [4]. The GCC comprises six intergovernmental states: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates, which share similar cultures and lifestyles [5].

GCC countries also experienced a more substantial increase in EO-CRC incidence compared to the global average [6]. However, the underlying reasons for this upward trend remain largely unclear [7,8] necessitating further research to identify the drivers. The notable increase in EO-CRC in GCC countries can be attributed to several potential factors, including deficiencies in screening management [9], [10], [11] and the adoption of Westernized lifestyles [12]. The rapid escalation of CRC is also attributable to the higher prevalence of CRC risk factors within these populations. Over the past three decades, the GCC nations have undergone significant socio-demographic transformations due to modernization, resulting in substantial shifts in behavior and lifestyle that have had a notable impact on public health [13], [14], [15]. During this period, various CRC risk factors, including physical inactivity, smoking, red meat consumption, and obesity, have become notably prevalent among the younger generation [16], [17]. Thus, a comprehensive evaluation of the rise in EO-CRC in GCC countries is critical for devising effective prevention and intervention strategies to mitigate its impact on public health and the healthcare system in the region.

Colorectal cancer demonstrates significant biological heterogeneity, which is evident in the varying incidence rates of different cancer subtypes across different populations [18]. However, there have been limited investigations into CRC and EO-CRC across GCC countries and whether these differences vary over time. Therefore, prioritizing CRC and EO-CRC studies in these regions is crucial for gaining a comprehensive understanding and implementing effective disease management strategies. In this current study, we employed disability-adjusted life years (DALYs) as a pivotal metric for assessing the overall burden of both CRC and EO-CRC. DALYs represent the most comprehensive and widely accepted index for evaluating the burden of disease, encompassing the healthy years of life, years lost due to premature mortality (YLLs), and years lived with disability (YLDs) [19,20]. DALYs serve to combine the impact of diseases on population health by considering not only premature mortality and disability but also factors such as age, disease severity, and discount rates that contribute to their relative importance. A more comprehensive explanation of DALYs, YLLs, and YLDs can be found in our prior study [19].

The aim of this study was twofold: first, to offer an up-to-date assessment of the overall burden of CRC, and EO-CRC in GCC countries and to project its future trends over an extended timeframe. Second, it sought to uncover the epidemiological patterns of CRC, and EO-CRC in these countries, which have been infrequently documented. These insights can be invaluable for policymakers in formulating more effective strategies and interventions to mitigate the CRC burden.

Methods and materials

Data source

The data was obtained from The Global Burden of Disease (GBD) 2019. The GBD provided inclusive and accessible epidemiological data on 369 diseases and injuries, as well as 87 risk factors, from 1990 to 2019. This comprehensive data encompasses 7 super-regions, 21 regions, and more than 200 countries and territories, and was obtained using a rigorous methodology previously described [21,22].

Definition of Early Onset Colorectal Cancer (EO-CRC)

In this study, we classified all cancers identified as C18-21, D01.0-D01.2, and D12-D12.9 according to the 11th revision of the International Classification of Diseases as CRCs. We included both colon and rectal carcinomas based on the colorectal continuum model [23]. EO-CRC was defined as CRC diagnosed before the age of 50 particularly, we used the age category of 15 to 49 years old. To obtain the necessary data, we utilized the Global Health Data Exchange (GHDx) tool (https://ghdx.healthdata.org/gbd-2019, accessed on 15 August 2023) and selected "colon and rectum cancer" as the "cause" and "incidence," and "deaths," as the "measure." And then we followed the inclusion criteria for selecting the included countries and regions. This study focused on high-risk populations aged 15 to 49 years old in high-income and high-middle income countries located the Middle East particularly Gulf Cooperation Council [24] Countries included were Saudi Arabia, Kuwait, the United Arab Emirates, Qatar, Bahrain, and Oman.

Estimation of the Disease Burden of CRC in GBD 2019

We used the epidemiological metrics prevalence, incidence, mortality, Years lived with disabilities (YLDs), and Disability-adjusted life years (DALYs). The prevalence rate (per 100,000) is derived from the total number of both new and existing cases, divided by the population size. Meanwhile, the incidence rate (per 100,000) is computed by dividing the number of new cases by the total population. YLDs were calculated by multiplying the number of new cases by the disability weight, and then by the average duration individuals lived with the disease before experiencing remission or death. DALYs which represent the combined impact of disease, were obtained by summing years of life lost (YLLs) and YLDs. Finally, the mortality rate was estimated by dividing the number of deaths per year by the total population size, with the result expressed as the number of deaths per 100,000 individuals [25].

Statistical Analysis

Rates were all standardized based on the global standard population as reported by the GBD 2019 (Vos, 2020). Uncertainty intervals (UIs) for each metric were generated using the 2.5th and 97.5th percentiles, and it was incorporated it into the GBD modeling process [26]. The rates are presented per 100,000 population. To determine the average annual percent change and its corresponding 95 % confidence interval (CI) for total CRC and EO-CRC, we employed joinpoint regression analysis using the Joinpoint Regression Program software (version 4.9.1.0 which is developed by the Statistical Research and Applications Branch of the National Cancer Institute in the U.S.) [27]. The software utilized trend data and employed the simplest joinpoint model that the data could support. The process begins with a zero joinpoint, essentially representing a straight-line trend, and assesses whether additional joinpoints are statistically significant and should be incorporated into the model. Significance testing was conducted using the Monte Carlo Permutation method [27].

We used Age-period-cohort (APC) models for predicting the CRC, and EO-CRC incidence and mortality rate for the next ten years from 2020 to 2030. APC is grounded in Poisson distributions, and it's known for its strong predictive capability in forecasting the incidence and mortality patterns of various cancer types [28]. Due to due to the exponential growth in rate over time, there is a potential overestimation of the cancer number of cases. To improve the predictions, we used different power functions based on the level of each exponential growth [29]. We calculated the anticipated counts of new cancer cases and mortalities for the time period from 2020 to 2030 by projecting the incidence and mortality rates within each age group. These projections were based on observed rates up to 2019. Subsequently, we multiplied these rates by the projected population. We conducted all analyses utilizing different programs, SAS 9.4, and Jointpoint software.

Results

The annual average percentage changes (AAPC) in prevalence, incidence, and mortality per 100,000 of age-standardized total CRC, and EO-CRC from 1990 to 2019

The AAPC in prevalence, incidence, and mortality of both age-standardized CRC, and EO-CRC increased remarkably in both genders from 1990 to 2019. Overall, all six countries showed higher average percentage changes in incidence rate for EO-CRC compared to CRC. Four (Saudi Arabia, Kuwait, Bahrain, and the United Arab Emirates) out of the six countries had more increase in prevalence, and mortality rates of EO-CRC than CRC (Tables 1, and 2). The highest AAPC in incidence rate per 100,000 were among Saudis male EO-CRC 3.19; (95 % UI 1.2,7.05) per 100,000, followed by male EO-CRC Kuwaitis 1.55; (95 % UI -0.07,0.77) per 100,000. The highest AAPC increase in prevalence rate was among EO-CRC males, and females in Saudi Arabia with 4.22; 95 % Uncertainty Interval (UI) 1.82,8.58), 3.61; (95 % UI 1.51,6.98) per 100,000 increased from 1990 to 2019 respectively. The prevalence rates of EO-CRC among Saudis were nearly two times increased at 4.04; (95 % UI 2.00,7.11) per 100,000 than CRC 2.12; (95 % UI 1.02,3.64) per 100,000 (Tables 1, and 2). The same patterns were observed in United Arab Emirates, and Bahrain as the prevalence of EO-CRC rates was nearly 4, and 2.5 times increased; 1.27; (95 % UI 0.28,2.89), 1.7; (95 % UI 0.93,2.68) per 100,000 than CRC 0.28 (95 % UI -0.23,0.99), 0.62; (95 % UI 0.2,1.31) per 100,000 respectively. The AAPC in mortality rate was the highest among both genders in Saudi Arabia, Kuwait, and the United Arab Emirates and it was higher in proportion from 1990 to 2019 among Saudi Arabia, and the United Arab Emirates EO-CRC compared to CRC for the two countries (Tables 1, and 2).

Table 1.

Average annual percentage changes1 in prevalence, incidence, mortality rates, YLD2 and DYLD3 of total CRC in gulf countries from 1990-2019 (age-standardized).

	Prevalence %			Incidence%			Mortality %			YLD %			DYLD %
	Both 95 %UI4	Male 95 %UI	Female 95 %UI	Both 95 %UI	Male 95 %UI	Female 95 %UI	Both 95 %UI	Male 95 %UI	Female 95 %UI	Both 95 %UI	Male 95 %UI	Female 95 %UI	Both 95 %UI	Male 95 %UI	Female 95 %UI
KSA5	2.12 (1.02,3.64)	2.33 (1.08,4.2)	1.69 (0.67,3.2)	1.31 (0.47, 2.6)	1.46 (0.5, 3.3)	1.06 (0.22,2.)	0.42 (-0.11,1.2)	0.49 (-0.08,1.62)	0.35 (-0.2,1.31)	1.61 (0.7,2.9)	1.79 (0.71,3.7)	1.26 (0.34,2.)	0.47 (0.08,1.	0.53 (-0.07,1.6)	0.39 (-0.18,1.3)
Kuwait	1.1 (0.72,1.57)	1.73 (1.11,2.53)	0.22 (-0.04,0.53)	0.76 (0.46,1.15)	1.36 (0.86,2)	0.03 (-0.17,0.3)	0.38 (0.16,0.65)	0.83 (0.47,1.29)	-0.1 (-0.28,0.13)	0.88 (1.38,0.5)	1.47 (0.85,2.32)	0.1 (-0.17,0.41)	0.26) (0.06,0.53)	0.67 (0.31,1.12)	-0.19 (-0.36,0.01)
Oman	1.11 (0.37,2.14)	1.27 (0.42,2.63)	0.9 (0.2,1.96)	0.7 (0.09,1.66)	0.85 (0.13,2.18)	0.55 (0-0.03,1.57)	0.32 (-0.14,1.08)	0.39 (-0.13,1.42)	0.27 (-0.18,1.13)	0.84 (0.18,1.79)	0.99 (0.21,2.28)	0.66 (-0.02,1.8)	0.17 (-0.26,0.82)	0.2 (-0.27,1.09)	0.15 (-0.3,0.88)
Bahrain	0.62 (0.2,1.31)	0.63 (0.16,1.39)	0.43 (0.05,0.94)	0.2 (-0.12,0.7)	0.17 (0.17,0.74)	0.14 (-0.17,0.74)	-0.08(-0.32,0.26)	-0.13 (-0,37,0.27)	-0.04 (-0.31,0.31)	0.36 (-0.04,0.97)	0.36 (-0.08,1.06)	0.24 (-0.15,0.77)	0.36 (-0.04,0.97)	0.36 (-0.08,1.06)	0.24 (-0.15,0.77)
Qatar	1.22 (0.51, 2.15)	1.43 (0.44,2.88)	1.16 (0.55,2.08)	0.61 (0.1,1.35)	0.8 (0.09,1.94)	0.71 (0.22,1.61)	0.17 (-0.18,0.75)	0.3 (-0.16,1.08)	0.39 (-0.05,1.19)	0.83 (0.24,1.62)	1.01 (0.2,2.29)	0.84 (0.24,1.62)	0.04 (-0.29,0.49)	0.12 (-0.32,0.84)	0.14 (-0.19,0.67)
UAE5]	0.28 (-0.23,0.99)	0.32 (-0.25,1,36)	0.06 (-0.45,0.78)	0.08 (-0.36,0.71)	0.09 (-0.39,1.08)	-0.08 (-0.56,0.62)	0.06 (-0.44,0.48)	0.07 (-0.47,0.77)	0.17 (-0.44,0.48)	0.17 (-0.3,0.88)	0.19 (-0.34,1.12)	-0.02 (-0.53,0.7)	-0.1 (-0.48,0.45)	-0.08 (-0.49,0.75)	-0.18 (-0.16,0.43)

1 percentage change from 1990 to 2019

² years of life lived with disability (YLD)

³ disability-adjusted life years (DALYs)

⁴ 95 % Uncertainty interval

⁵ Saudi Arabia (KSA), United Arab Emirates (UAE)

Table 2.

Average annual percentage changes1 in prevalence, incidence, mortality rates, YLD2 and DYLD3 of EO-CRC in gulf countries from 1990-2019 (age 15-49).

	Prevalence			Incidence			Mortality			YLD			DYLD
	Both 95 %UI4	Male 95 %UI	Female 95 %UI	Both 95 %UI	Male 95 %UI	Female 95 %UI	Both 95 %UI	Male 95 %UI	Female 95 %UI	Both 95 %UI	Male 95 %UI	Female 95 %UI	Both 95 %UI	Male 95 %UI	Female 95 %UI
KSA5	4.04 (2,7.11)	4.22 (1.82,8.58)	3.61 (1.51,6.98)	3.05 (1.35,5.72)	3.19 (1.2,7.05)	2.79 (1.01,5.82)	1.16 (0.23,2.78)	1.19 (0.15,3.2)	1.13 (.12,2.86)	3.46 (1.62,6.46)	3.1 (1.53,7.84)	3.1 (1.18,6.36	1.16 (0.24,2.73)	1.21 (0.17,3.19)	1.09 (0.11,2.8)
Kuwait	1.24 (0.74,1.89)	1.87 (1.05,2.94)	0.48 (0.07,0.98)	0.96 (0.54,1.53)	1.55 (-0.07,0.77)	0.3 (-0.07,0.77)	0.35 (0.08,0.73)	0.66 (0.18,1.28)	0.03 (-0.26,0.41)	1.1 (0.59,1.81)	1.7 (0.87,2.93)	0.4 (-0.07,1.01)	0.33 (0.06,0.68)	0.64 (0.18,1.21)	0.01 (-0.27,0.36)
Oman	0.94 (0.16,2.11)	0.96 (0.09,2.43)	0.79 (-0.02,2.01)	0.56 (-0.11,1.6)	0.57 (-0.17,1.87)	0.47 (-0.24,1.63)	0.04 (-0.045,0.57)	-0.08 (-0.51,0.67)	-0.05 (-0.46,0.87)	0.77 (0.03,1.93)	0.79 (-0.04,2.19)	0.63 (-0.17,2.05)	-0.01 (-0.43,0.6)	-0.05 (-0.048,0.7)	0.07 (-0.44,0.88)
Bahrain	1.7 (0.93,2.68)	1.94 (1,3.2)	1.19 (0.93,2.68)	1.18 (0.53,2.01)	1.37 (0.59,2.46)	0.83 (0.22,1.68)	0.41 (-0.01,0.96)	0.43 (-0.05,1.09)	0.38 (-0.08,1.04)	1.44 (0.68,2.46)	1.65 (0.71,3)	1 (0.29,1.94)	0.36 (-0.04,0.88)	0.4 (-0.06,1.03)	0.32 (-0.12,0.93)
Qatar	1.19 (0.4,2.28)	1.55 (0.5,3.02)	0.69 (-0.02,1.79)	0.74 (0.07,1.75)	1.09 (0.17,2.51)	0.34 (-0.27,1.3)	0.04 (-0.4,0.48)	0.09 (-0.38,0.83)	0.11 (-0.5,0.54)	0.97 (0.2,2.08)	1.3 (0.28,2.79)	0.53 (-0.16,1.63)	-0.03 (-0.39,0.05)	0.11 (-0.36,0.84)	-0.11 (-0.5,0.51)
UAE5	1.27 (0.28,2.89)	1.37 (0.25,3.76)	1.01 (0.05,2.56)	1.03 (0.08,2.67)	1.13 (0.04,3.69)	0.86 (-0.11,2.56)	0.62 (-0.13,1.9)	0.64 (-0.2,2.7)	0.65 (-0.21,2.17)	1.12 (0.2,2.75)	1.22 (0.1,3.69)	0.92 (-0.03,2.55)	1.12 (0.2,2.75)	0.92 (-0.03,2.55)	1.12 (0.2,2.75)

¹ percentage change from 1990 to 2019

² years of life lived with disability (YLD)

³ disability-adjusted life years (DALYs)

⁴ 95 % Uncertainty interval

⁵Saudi Arabia (KSA), United Arab Emirates (UAE)

The gender difference in the burden (DYLD) of age-standardized total CRC, and EO-CRC

The AAPC from 1990 to 2019 of the burden of EO-CRC for both genders was higher among all countries except Oman -0.01 (95 % UI -0.43,0.6) and Qatar -0.03 (95 % UI -0.39,0.05) where the burden of EO-CRC was lower. The AAPC burden of EO-CRC in both genders, for Saudi Arabia and United Arab Emirates 1.16 (95 % UI 0.24,2.73, 1.12 (95 % UI 0.2,2.75) respectively were nearly double than burden of 0.47 (95 % UI 0.08,1.3), -0.1 (95 % UI -0.48,0.45) CRC. The AAPC from 1990 to 2019 of the burden of EO-CRC and CRC was higher in male compared to female in all gulf countries except for the United Arab Emirates and Oman where the female burden of EO-CRC 1.12 (UI 95 % 0.2,2.75), 0.07 (UI 95 % -0.44,0.88) was higher than male 0.92 (95 % UI -0.03,2.55), -0.05 (95 % UI -0.048,0.7) respectively (Table.1, and 2).

Temporal trends changes in prevalence, incidence, mortality, and the burden (DYLD) of age-standardized total CRC, and EO-CRC from 1990 to 2019

The AAPC from 1990 to 2019 of the burden of EO-CRC for both genders was higher among all countries except Oman -0.01 (95 % UI -0.43,0.6) and Qatar -0.03 (95 % UI -0.39,0.05) where the burden of EO-CRC was lower. The AAPC burden of EO-CRC in both genders, for Saudi Arabia and the United Arab Emirates 1.16 (95 % UI 0.24,2.73, 0.92 (95 % UI -0.03,2.55) respectively were nearly double the burden of 0.47 (95 % UI 0.08,1.3), -0.1 (95 % UI -0.48,0.45) CRC. The AAPC from 1990 to 2019 of the burden of EO-CRC and CRC was higher in males compared to females in all Gulf countries except for the United Arab Emirates and Oman where the female burden of EO-CRC 1.12 (UI 95 % 0.2,2.75), 0.07 (UI 95 % -0.44,0.88) was higher than male 0.92 (95 % UI -0.03,2.55), -0.05 (95 % UI -0.048,0.7) respectively (Table.1, and 2).

Temporal trend changes in prevalence, incidence, mortality, and the burden (DYLD) of age-standardized total CRC, and EO-CRC from 1990 to 2019

In Fig. 1, Fig. 2, overall, there was a constant increase in the prevalence and incidence rates from 1990 to 2019 across all countries with various acceleration rates. The acceleration increased the rate of the temporal trends for the prevalence, and incidence rates for EO-CRC rates were sharper and larger compared to CRC in all Gulf countries except for Oman. In Oman, the temporal trends of the prevalence, and incidence rates had a steady and slight increase over the years 1990 to 2019 (Figs. 1 and 2). The mortality rates fluctuated in all countries over the study period from 1990 to 2019 with a slightly higher increase among the EO-CRC population toward the end of the study period (2014 to 2019) in Saudi Arabia, United Arab Emirates, and Bahrain (Fig. 3, and 4).

Fig. 1.

Temporal trends of incidence, and mortality rate per 100,000 of age-standardized CRC and EO-CRC from 1990 to 2019.

Fig. 2.

Temporal trends of YLD, and DAYLD rate per 100,000 of age-standardized CRC and EO-CRC from 1990 to 2019.

Fig. 3.

Prediction of mortality rate per 100,000 of age-standardized CRC and EO-CRC from 2020 to 2030.

Fig. 4.

Prediction of incidence rate per 100,000 of age-standardized CRC and EO-CRC from 2020 to 2030.

The highest increase in CRC and EO-CRC prevalence was in Saudi Arabia. In Saudi Arabia the number of CRC cases has increased from 1990 1484.57; (95 % UI 1987.98,1083.86) 11.4-fold-increase to 16991.83; (95 % UI 21754.79,12892.12) in 2019. While the number of cases of EO-CRC was 454.44; (95 % UI 647.33,316.91) in 1990 and has increased substantially to 6893.38; (95 % UI 9671.42, 4891.44) in 2019, 14.1-fold-increase (Supplements Table 1). In Bahrain the number of CRC cases has increased from 97.25; (95 % UI 113.11, 81.98) in 1990 to 880.22; (95 % UI 1139.48, 666.48) in 2019, an 8-fold increase. The number of cases of EO-CRC was 29.51; (95 % UI 35.57,24.28) in 1990 and has increased substantially to 243.34; (UI 95 % 314.5, 181.97) in 2019 7.5-fold-increase (Supplements Table 1). Similar patterns were observed in the United Arab Emirates with an 11.1-fold increase in prevalence of CRC and a 9-fold increase in EO-CRC (Supplements Table 1). The burden of EO-CRC was higher than CRC in Saudi Arabia (5.5-fold-increase vs 4.1-fold-increase), (Supplements Table 3).

Predictions of incidence and mortality of Total CRC and EO-CRC from 2020 to 2030

In the next 10 years, the gender-adjusted incident cases of EO-CRC will increase linearly in all Gulf countries. Death cases will increase in Saudi Arabia, Kuwait, and Bahrain, and it will decrease in Qatar and Oman (Figs. 3, and 4). The increase in the EO-CRC incident rate was higher and sharper across all countries compared to the CRC incident rate. The most significant steeper increase in incidence and mortality rate per 100,000 of total CRC and EO-CRC will be expected in Saudi Arabia (Figs. 3, and 4). Looking ahead to 2030, the combined population of the six Gulf countries is estimated to reach 64,553,600 million. During this period, the total incidence cases of CRC are expected to reach 13,339 thousand, primarily driven by Saudi Arabia with 7,910.19 cases and the United Arab Emirates with 2,155.93 CRC cases (as detailed in Supplements Tables 4, and 5). Similarly, by 2030, the total number of expected EO-CRC cases for all countries combined will reach 1,669 thousand, with a substantial 70 % of these cases concentrated in Saudi Arabia (1,168 cases). Comparable patterns emerge in mortality rates, where the combined CRC mortality by 2030 is projected to be 7,647 cases, with nearly 57 % of CRC mortality cases anticipated in Saudi Arabia (4,338 cases). For EO-CRC, the total combined mortality cases will be 677, with approximately 70 % of these fatalities expected in Saudi Arabia (471 cases) (as indicated in Supplements Tables 4, and 5).

Discussion

The study reveals concerning trends in CRC and EO-CRC across the Gulf countries from 1990 to 2019. Both CRC and EO-CRC witnessed substantial increases in prevalence, incidence, and mortality rates, with incidence rates for EO-CRC consistently higher than those for CRC with an evident male predominance. Notably, Saudi Arabia experienced the most significant rise in both CRC and EO-CRC prevalence, highlighting a pressing public health issue. In 2019, the number of people living with CRC in GCC countries was 26,705, which was nearly eleven times higher than that in 1990. Furthermore, more than 60 % of the number of people living with CRC in GCC countries was in Saudi Arabia. The non-fatal burden (YLDs) of CRC, and EO-CRC increased during the last three decades in all GCC countries. While the burden (DYLD) of CRC, and EO-CRC increased in half of the GCC countries. The highest burden increase was among Saudis with EO-CRC. Looking ahead to 2030, CRC incidence is projected to increase significantly to 13,339 new cases, primarily driven by Saudi Arabia with 7,910.19 new cases, while EO-CRC is also expected to become a notable health concern, particularly in the same country. In addition, the present study found that CRC-related deaths will continuously increase in the next 10 years in four GCC countries. Urgent interventions and healthcare strategies are needed to address these escalating trends and reduce the burden of CRC and EO-CRC, emphasizing the importance of continued surveillance and prevention efforts in the Gulf region.

In line with a previous study, the incidence and prevalence of CRC in the present study showed an upward trend over the past three decades in GCC countries [30,31]. The consistent increase in incidence rates for both CRC and EO-CRC suggests several possible factors contributing to this trend. One key factor could be the adoption of Westernized lifestyles in these countries [32]. As these nations have undergone rapid socioeconomic development and urbanization, lifestyle changes, including dietary habits and physical activity levels, have shifted towards a more sedentary and calorie-rich pattern, which is known to increase CRC risk [15]. Previous research suggests that by addressing, and reducing well-known modifiable risk factors, it is possible to prevent a significant portion of CRC cases [32,33]. These risk factors include factors such as smoking, obesity, and physical inactivity. Therefore, it is essential for public health policymakers to implement regulations and policies aimed at controlling these risk factors. Doing so can help reduce the future burden of CRC.

Furthermore, our observation of higher average percentage changes in incidence rates for EO-CRC compared to CRC deserves special attention. It suggests a more rapid increase in the number of cases among younger age groups. The highest AAPC for EOCRC in the present study was Saudi Arabia with 3.05 (95 % UI 1.35, 5.72), which had been reported to be 3.06 in China, 2.8 in Canada and Australia, and 2.2 in the United States [34,35]. The rising incidence of early-onset CRC can be attributed to various factors. This includes countries with a substantial proportion of young populations, where approximately 70 % to 85 % of the residents fall within the age range of 15 to 49 years [30,36]. This demographic composition places these nations at an elevated risk for EO-CRC. However, the rapid rise in EO-CRC incidence has remained inadequately explained, as the CRC risk factors typically associated with adulthood do not entirely account for this trend. Many epidemiological investigations into EO-CRC have traditionally focused on adult exposures, neglecting early-life factors. However, recent findings have brought to light a potential link between increased EO-CRC risk and early-life factors such as childhood consumption of dairy products, adolescent obesity, and exposure to radiation during childhood [37], [38], [39].

Given the projected incidence and mortality of CRC and the rising incidence of EO-CRC in several GCC countries, it is imperative for national policymakers and public health authorities to prioritize the development of effective screening methods, interventions, and treatment approaches. Previous research has indicated that addressing known modifiable risk factors could potentially prevent up to half of all CRC cases [32,33]. Therefore, it is crucial for public health policymakers to establish comprehensive regulations and policies targeting these modifiable risk factors, including alcohol consumption, smoking, obesity, and physical inactivity, to mitigate the future burden of CRC in GCC countries. Identifying high-risk populations for earlier and more intensive screening efforts is also essential. Furthermore, increased support for research initiatives aimed at elucidating the underlying biological mechanisms of CRC is warranted to facilitate early diagnosis and precision treatment. These studies have underscored the significant roles played by genetic and environmental factors, as well as their interactions, in the progression of CRC [40]. Additionally, research has indicated that specific dietary components and their interplay with genetic variations can impact CRC risk [41]. Moreover, individuals with a higher genetic susceptibility may derive greater benefits from adopting a healthier lifestyle [42]. While ongoing research continues to explore these complex questions, advancements in technology, including experimental models and methodological tools, hold promise for uncovering mechanistic insights. These insights can ultimately inform public health recommendations and contribute to the reduction of CRC incidence and mortality.

Strength and limitations

Utilizing the most recent data from GBD 2019, this research offers a comprehensive evaluation of CRC burden. Notably, it represents the first attempt, to the best of our knowledge, to forecast the trajectory of CRC and EO-CRC incidence and mortality trends in GCC countries up to 2030. Despite its strength, this study also bears certain limitations. Firstly, the predictive models did not account for specific risk factors in the estimation of CRC incidence and mortality. Secondly, due to data source constraints, we were unable to stratify for colon and rectal cancers. Thirdly, it's important to acknowledge that our study shares the general limitations associated with GBD research, including factors like the availability and quality of primary data.

Conclusion

In conclusion, this study sheds light on the alarming rise in CRC and EO-CRC across Gulf countries from 1990 to 2019, emphasizing Saudi Arabia's significant burden. It projects a concerning increase in CRC incidence and mortality by 2030, primarily in Saudi Arabia, and highlights the need for immediate public health interventions. Lifestyle changes and modifiable risk factors contribute to these trends, underscoring the importance of policy regulations. The sharp increase in CRC rates, especially among younger age groups, remains a pressing concern with potential links to early-life factors. To address this expanding public health issue, policymakers need to prioritize screening, interventions, and CRC emphasized research.

Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of King Abdullah International Medical Research Center (KAIMRC). The Biomedical ethics committee in KAIMRC has exempt the study from obtaining IRB approval due to the use pf public use data. All methods were performed in accordance with the relevant guidelines and regulations of KAIMRC.

Consent for publication

All authors have a greed to publish the current manuscript.

Availability of data and material

The data that support the findings of this study are available from [Global Burden of Disease study]. No restrictions apply to the availability of these data, which were used under Public Use Files (PUF) data. Data are available [at https://vizhub.healthdata.org/gbd-result].

Funding

“No funding received”

CRediT authorship contribution statement

Majed Ramadan: Conceptualization, Methodology, Software, Data curation, Writing – original draft, Visualization, Investigation, Supervision, Writing – review & editing, Software, Validation. Hanin Ghamdi: Investigation. Doaa Aboalola: Investigation, Software, Validation. Noha Alorainan: Investigation. Ragad Alsalmi: Investigation. Ahmed Afash: Investigation. Albaraa Hariri: Investigation, Writing – review & editing. Atheer Alboloshi: Investigation, Writing – review & editing, Software, Validation. Alaa Samkari: Data curation, Writing – original draft. Rawiah Alsiary: Supervision, Writing – review & editing, Software, Validation.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.