Summary
Background
Colorectal cancer poses a major global health threat, with increasing incidence and mortality rates worldwide. This study examined the incidence and mortality rates of colorectal cancer globally in 2020 and explored the relationship with the Human Development Index (HDI).
Material and methods
This research utilizes data from the International Agency for Research on Cancer’s (IARC) GLOBOCAN 2020 project, an esteemed source of up-to-date international cancer statistics. Age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR) per 100,000 individuals were calculated. The association between ASIR, ASMR, and the HDI was analyzed using Pearson correlation, considering a statistical significance threshold of p < 0.05.
Results
In 2020, a total of 1,931,590 new colorectal cancer cases were recorded globally, with a male predominance of 55.18%. The global colorectal cancer ASIR was 19.5 per 100,000 (23.4 in males, 16.2 in females). Furthermore, there were 935,173 colorectal cancer-related mortality, with males accounting for 55.13%. The overall colorectal cancer ASMR was 9 (11 in males, 7.2 in females). A strong positive correlation emerged between ASIR and ASMR (0.895, p ≤ 0.001), HDI (0.794, p ≤ 0.001), life expectancy (0.724, p ≤ 0.001), education (0.743, p ≤ 0.001), and income (0.706, p ≤ 0.001). Similarly, positive correlations were also found between ASMR and HDI (0.638, p ≤ 0.001), life expectancy (0.569, p ≤ 0.001), education (0.631, p ≤ 0.001), and income (0.512, p ≤ 0.001).
Conclusions
This global analysis highlights rising colorectal cancer incidence and mortality as a major public health threat worldwide. The findings reveal a positive association between a country’s development level, as measured by HDI, and colorectal cancer incidence and mortality.
Keywords: Incidence, Mortality, Colorectal cancer, Geographical disparities, Human Development Index
Introduction
Colorectal cancer poses a major global health concern, with rising incidence and mortality rates worldwide [1, 2]. In 2018, there were 1,849,518 new cases of colorectal cancer, accounting for 10% of all newly diagnosed cancers globally [3]. Additionally, there were 880,792 deaths attributed to colorectal cancer, representing 9.2% of all cancer-related deaths [3]. It ranks third among the most common cancers and stands as the second leading cause of cancer-related deaths [1, 2]. The geographical distribution of colorectal cancer exhibits substantial disparities, with higher rates reported in developed countries compared to developing nations [4]. These variations can be attributed to differences in risk factors, healthcare infrastructure, and socioeconomic factors [5, 6].
Colorectal cancer arises from the malignant transformation of the colon or rectal epithelium and is influenced by a complex interplay of genetic and environmental factors [7]. Lifestyle choices, such as diet, physical activity, and tobacco use, have been identified as modifiable risk factors for colorectal cancer [8, 9]. Additionally, age, family history of the disease, and certain hereditary syndromes contribute to an individual’s susceptibility to colorectal cancer [10]. This highlights the need for public health strategies promoting increased physical activity, healthy diets, smoking cessation, and other beneficial lifestyle changes as part of comprehensive colorectal cancer control.
Research on the global burden of colorectal cancer has identified the Human Development Index (HDI) as a significant factor influencing its incidence and mortality rates. The HDI is a composite metric of social and economic development that includes factors such as life expectancy, education, and income [11]. Research has shown a positive correlation between higher HDI levels and increased colorectal cancer incidence, attributed to increased availability and utilization of screening and diagnostic procedures in more developed nations [4, 12, 13]. In 2018, the incidence of colorectal cancer was highest in areas with very high HDI, with a rate of 61.4 cases per 100,000 population. High HDI areas had an incidence rate of 24.1, followed by medium HDI areas at 6.35, and low HDI areas at 3.6. The mortality rate due to colorectal cancer also varied based on the level of development, with very high HDI areas having a mortality rate of 27.1, followed by high HDI areas at 13, medium HDI areas at 3.9, and low HDI areas at 2.75 [3].
Though colorectal cancer incidence has declined in some high-income countries, it is rising in several low- and middle-income regions, underscoring the pressing need for comprehensive prevention and control strategies [14]. Early detection through screening programs, coupled with effective treatment modalities, can significantly improve patient outcomes and reduce mortality rates [1].
This paper aims to explore global colorectal cancer incidence, mortality, and geographical disparities, correlating them with the HDI. By analyzing available data, we aim to pinpoint key drivers of the colorectal cancer burden and propose evidence-based strategies for prevention, early detection, and treatment. Understanding the worldwide landscape of colorectal cancer is vital for guiding public health policies and interventions to mitigate its impact on individuals and communities.
Materials and methods
This research utilizes data from the International Agency for Research on Cancer’s (IARC) GLOBOCAN 2020 project, an esteemed source of up-to-date international cancer statistics. The database includes information on the incidence and mortality rates of different types of cancer across 184 countries. It covers a wide range of cancer types, age groups, genders, and global regions. Developed by the World Health Organization (WHO), GLOBOCAN enables researchers to thoroughly investigate and compare cancer rates based on multiple criteria. As a highly reliable data source, GLOBOCAN provides the foundation for analyzing colorectal cancer incidence and mortality in this study [14-16].
This study primarily analyzes the Age-Standardized Incidence Rate (ASIR) and Age-Standardized Mortality Rate (ASMR) of colorectal cancer. The analysis categorizes and presents the rates based on multiple criteria: Continents: Latin America and Caribbean, Africa, Northern America, Oceania, Europe, Asia. WHO regions: Africa (AFRO), East Mediterranean (EMRO), Americas (PAHO), South-East Asia (SEARO), Europe (EURO), Western Pacific (WPRO). Global regions: Southeastern Asia, Western Asia, South-Central Asia, Eastern Asia, North America, South America, Central America, Middle Africa, Western Africa, Southern Africa, Northern Africa, Eastern Africa, Central/Eastern Europe, Southern Europe, Northern Europe, Western Europe, Caribbean, Australia/New Zealand, Melanesia, Micronesia, Polynesia. Income level: Low-income, lower-middle income, upper-middle income, High-income. The standardized rates allow comparative analysis of colorectal cancer incidence and mortality across these different geographic regions and economic groups.
HUMAN DEVELOPMENT INDEX (HDI)
The HDI is a comprehensive measure that assesses a country’s achievements in key dimensions of human development. These dimensions include education, life expectancy, and per capita income. By taking the geometric mean of normalized indices for each dimension, the HDI produces values that range from 0 to 1. In essence, the HDI provides a multi-faceted evaluation of human development by combining health, education, and economic prosperity metrics [17].
STATISTICAL ANALYSIS
This study presents 2020 incidence and mortality rates for colorectal cancer, including both raw and Age-Standardized rates per 100,000 individuals. Geographical distribution maps were created based on the Age-Standardized rates. The methodology has been extensively detailed in previous reports [12, 13, 18-20]. Specifically, the Pearson correlation method was used to analyze the relationship between ASIR and ASMR of colorectal cancer and the Human Development Index (HDI) and its components. A p-value < 0.05 was considered statistically significant, with all reported P-values being two-sided. SPSS software (Version 26.0, SPSS Inc.) performed the statistical analyses.
Results
GEOGRAPHICAL DISTRIBUTION IN THE WORLD
In 2020, there were 1,931,590 new global colorectal cancer cases - 1,065,960 (55.18%) in men and 865,630 (44.82%) in women. The ASIR was 19.5 overall, 23.4 for men and 16.2 for women. The sex ratio of new cases was 1.23 (Fig. 1).
Fig. 1.
Distribution of new Colorectal Cancer cases worldwide in 2020.
Additionally, 935,173 deaths were attributed to colorectal cancer that year. Of these, 515,637 (55.13%) occurred in men and 419,536 (44.87%) in women. The ASMR was 9 overall, 11 for men and 7.2 for women. The sex ratio for mortality was also 1.23 (Fig. 2).
Fig. 2.
Distribution of Colorectal Cancer mortality worldwide in 2020.
GEOGRAPHICAL DISTRIBUTION BASED ON THE CONTINENTS
For ASIR, Europe had the highest rate at 30.4 (37.9 for men, 24.6 for women), followed by Oceania at 29.8 (33.8 for men, 26.1 for women), then Northern America at 26.2 (29.4 for men, 23.4 for women). Rates were lower in Asia at 17.6 (21.1 for men, 14.3 for women), Latin America/Caribbean at 16.6 (18.7 for men, 15.1 for women), and Africa at 8.4 (9.4 for men, 7.6 for women). Asia had the highest proportion of cases (52.25%), followed by Europe (26.91%), North America (9.34%), Latin America/Caribbean (6.98%), Africa (3.42%), and Oceania (1.06%) (Tab. I, Fig. 1).
Tab. I.
The age-standardized incidence rate of Colorectal Cancer in different regions of the world in 2020.
| Population Numbers | All | Men | Women | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Numbers | Crude Rate | ASR (W) | Numbers | Crude Rate | ASR (W) | Numbers | Crude Rate | ASR (W) | ||
| World | 1 931 590 | 24.8 | 19.5 | 1 065 960 | 27.1 | 23.4 | 865 630 | 22.4 | 16.2 | |
| WHO regions | WHO Africa (AFRO) | 50 696 | 4.5 | 8.4 | 26 243 | 4.7 | 9.5 | 24 453 | 4.4 | 7.5 |
| WHO Americas (PAHO) | 315 518 | 30.8 | 20.7 | 162 356 | 32.2 | 23.3 | 153 162 | 29.5 | 18.5 | |
| WHO East Mediterranean (EMRO) | 50 403 | 6.9 | 9.0 | 28 269 | 7.5 | 10.2 | 22 134 | 6.3 | 7.9 | |
| WHO Europe (EURO) | 554 569 | 59.4 | 28.8 | 300 443 | 66.4 | 36.0 | 254 126 | 52.9 | 23.3 | |
| WHO South-East Asia (SEARO) | 141 928 | 7.0 | 7.0 | 83 942 | 8.1 | 8.5 | 57 986 | 5.9 | 5.5 | |
| WHO Western Pacific (WPRO) | 818 060 | 41.6 | 25.3 | 464 483 | 46.5 | 30.6 | 353 577 | 36.6 | 20.5 | |
| Continents | Africa | 66 198 | 4.9 | 8.4 | 34 060 | 5.1 | 9.4 | 32 138 | 4.8 | 7.6 |
| Asia | 1 009 400 | 21.8 | 17.6 | 576 754 | 24.3 | 21.1 | 432 646 | 19.1 | 14.3 | |
| Europe | 519 820 | 69.4 | 30.4 | 281 714 | 77.9 | 37.9 | 238 106 | 61.5 | 24.6 | |
| Latin America and the Caribbean | 134 943 | 20.6 | 16.6 | 67 218 | 20.9 | 18.5 | 67 725 | 20.4 | 15.1 | |
| Northern America | 180 575 | 49.0 | 26.2 | 95 138 | 52.1 | 29.4 | 85 437 | 45.9 | 23.4 | |
| Oceania | 20 654 | 48.4 | 29.8 | 11 076 | 51.8 | 33.8 | 9 578 | 44.9 | 26.1 | |
| Income levels | High income | 819 143 | 66.6 | 30.2 | 450 564 | 73.5 | 36.2 | 368 579 | 59.7 | 25.0 |
| Upper middle income | 887 025 | 30.4 | 21.4 | 490 846 | 33.4 | 25.5 | 396 179 | 27.3 | 17.8 | |
| Low middle income | 194 954 | 6.4 | 7.4 | 109 105 | 7.1 | 8.6 | 85 849 | 5.8 | 6.3 | |
| Low income | 29 542 | 4.9 | 8.8 | 14 959 | 5.0 | 9.7 | 14 583 | 4.8 | 8.0 | |
| Global regions | Australia and New Zealand | 19 644 | 64.8 | 33.2 | 10 491 | 69.6 | 37.4 | 9 153 | 60.0 | 29.2 |
| Caribbean | 11 454 | 26.3 | 18.2 | 5 327 | 24.8 | 18.5 | 6 127 | 27.8 | 17.8 | |
| Central America | 19 535 | 10.9 | 10.4 | 10 181 | 11.6 | 12.0 | 9 354 | 10.2 | 9.1 | |
| Central and Eastern Europe | 172 950 | 59.0 | 29.3 | 89 189 | 64.7 | 38.4 | 83 761 | 54.0 | 23.4 | |
| Eastern Africa | 18 306 | 4.1 | 7.9 | 8 888 | 4.0 | 8.6 | 9 418 | 4.2 | 7.5 | |
| Eastern Asia | 757 849 | 45.2 | 25.9 | 431 501 | 50.4 | 31.2 | 326 348 | 39.7 | 21.0 | |
| Melanesia | 804 | 7.2 | 11.4 | 466 | 8.2 | 14.2 | 338 | 6.2 | 9.0 | |
| Micronesia | 93 | 16.9 | 16.6 | 51 | 18.4 | 19.5 | 42 | 15.5 | 14.2 | |
| Middle Africa | 5 767 | 3.2 | 6.8 | 3 045 | 3.4 | 7.7 | 2 722 | 3.0 | 6.1 | |
| Northern Africa | 20 858 | 8.5 | 9.7 | 10 662 | 8.6 | 10.4 | 10 196 | 8.3 | 9.1 | |
| Northern America | 180 575 | 49.0 | 26.2 | 95 138 | 52.1 | 29.4 | 85 437 | 45.9 | 23.4 | |
| Northern Europe | 81 638 | 76.8 | 33.6 | 44 464 | 84.7 | 39.2 | 37 174 | 69.1 | 28.8 | |
| Polynesia | 113 | 16.5 | 15.5 | 68 | 19.6 | 19.2 | 45 | 13.4 | 11.9 | |
| South America | 103 954 | 24.1 | 18.5 | 51 710 | 24.4 | 20.6 | 52 244 | 23.9 | 16.8 | |
| South-Central Asia | 102 987 | 5.1 | 5.5 | 61 252 | 5.9 | 6.6 | 41 735 | 4.3 | 4.4 | |
| South-Eastern Asia | 106 995 | 16.0 | 14.8 | 60 505 | 18.1 | 18.4 | 46 490 | 13.9 | 11.9 | |
| Southern Africa | 7 684 | 11.4 | 13.7 | 3 919 | 11.8 | 16.7 | 3 765 | 11.0 | 11.7 | |
| Southern Europe | 123 588 | 80.6 | 31.9 | 71 009 | 94.7 | 40.6 | 52 579 | 67.0 | 24.5 | |
| Western Africa | 13 583 | 3.4 | 6.7 | 7 546 | 3.7 | 7.9 | 6 037 | 3.0 | 5.7 | |
| Western Asia | 41 569 | 14.9 | 16.8 | 23 496 | 16.1 | 19.9 | 18 073 | 13.6 | 14.0 | |
| Western Europe | 141 644 | 72.2 | 28.7 | 77 052 | 80.0 | 34.3 | 64 592 | 64.7 | 23.9 | |
For ASMR, Europe again had the highest rate at 12.3 (16.1 for men, 9.5 for women), followed by Oceania at 9.3 (11.2 for men, 7.5 for women). Rates were lower in Asia at 8.6 (10.6 for men, 6.8 for women), Latin America/Caribbean at 8.2 (9.7 for men, 6.8 for women), Northern America at 8.2 (9.4 for men, 7.3 for women), and Africa at 5.6 (6.3 for men, 5.0 for women). Mirroring incidence, Asia had the most deaths (54.15%) followed by Europe (26.17%), Latin America/Caribbean (7.42%), Northern America (6.84%), Africa (4.58%), and Oceania (0.81%) (Tab. II, Fig. 2).
Tab. II.
The age-standardized mortality rate of Colorectal Cancer in different regions of the world in 2020.
| Population Numbers | All | Men | Women | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Numbers | Crude Rate | ASR (W) | Numbers | Crude Rate | ASR (W) | Numbers | Crude Rate | ASR (W) | ||
| World | 935 173 | 12.0 | 9.0 | 515 637 | 13.1 | 11.0 | 419 536 | 10.9 | 7.2 | |
| WHO regions | WHO Africa (AFRO) | 34 132 | 3.0 | 5.8 | 17 634 | 3.2 | 6.7 | 16 498 | 2.9 | 5.2 |
| WHO Americas (PAHO) | 133 422 | 13.0 | 8.1 | 69 081 | 13.7 | 9.4 | 64 341 | 12.4 | 7.0 | |
| WHO East Mediterranean (EMRO) | 27 975 | 3.8 | 5.1 | 15 702 | 4.2 | 5.8 | 12 273 | 3.5 | 4.5 | |
| WHO Europe (EURO) | 263 314 | 28.2 | 12.0 | 141 801 | 31.3 | 15.6 | 121 513 | 25.3 | 9.3 | |
| WHO South-East Asia (SEARO) | 80 084 | 4.0 | 4.0 | 47 876 | 4.6 | 4.9 | 32 208 | 3.3 | 3.1 | |
| WHO Western Pacific (WPRO) | 396 048 | 20.2 | 11.5 | 223 433 | 22.4 | 14.3 | 172 615 | 17.9 | 9.0 | |
| Continents | Africa | 42 875 | 3.2 | 5.6 | 22 046 | 3.3 | 6.3 | 20 829 | 3.1 | 5.0 |
| Asia | 506 449 | 10.9 | 8.6 | 288 525 | 12.2 | 10.6 | 217 924 | 9.6 | 6.8 | |
| Europe | 244 824 | 32.7 | 12.3 | 131 885 | 36.5 | 16.1 | 112 939 | 29.2 | 9.5 | |
| Latin America and the Caribbean | 69 435 | 10.6 | 8.2 | 34 976 | 10.9 | 9.4 | 34 459 | 10.4 | 7.3 | |
| Northern America | 63 987 | 17.3 | 8.2 | 34 105 | 18.7 | 9.7 | 29 882 | 16.0 | 6.8 | |
| Oceania | 7 603 | 17.8 | 9.3 | 4 100 | 19.2 | 11.2 | 3 503 | 16.4 | 7.5 | |
| Income levels | High income | 340 272 | 27.6 | 10.5 | 185 111 | 30.2 | 13.2 | 155 161 | 25.1 | 8.2 |
| Upper middle income | 461 511 | 15.8 | 10.8 | 256 244 | 17.5 | 13.3 | 205 267 | 14.1 | 8.6 | |
| Low middle income | 112 556 | 3.7 | 4.3 | 63 703 | 4.1 | 5.1 | 48 853 | 3.3 | 3.6 | |
| Low income | 20 392 | 3.4 | 6.2 | 10 343 | 3.4 | 6.9 | 10 049 | 3.3 | 5.5 | |
| Global regions | Australia and New Zealand | 7 038 | 23.2 | 9.5 | 3 755 | 24.9 | 11.4 | 3 283 | 21.5 | 7.7 |
| Caribbean | 6 983 | 16.0 | 10.4 | 3 307 | 15.4 | 11.0 | 3 676 | 16.7 | 9.8 | |
| Central America | 10 439 | 5.8 | 5.5 | 5 494 | 6.2 | 6.4 | 4 945 | 5.4 | 4.7 | |
| Central and Eastern Europe | 93 384 | 31.9 | 14.5 | 48 378 | 35.1 | 20.2 | 45 006 | 29.0 | 11.0 | |
| Eastern Africa | 13 236 | 3.0 | 5.9 | 6 365 | 2.9 | 6.4 | 6 871 | 3.1 | 5.5 | |
| Eastern Asia | 368 072 | 21.9 | 11.8 | 208 090 | 24.3 | 14.7 | 159 982 | 19.4 | 9.2 | |
| Melanesia | 452 | 4.1 | 6.7 | 279 | 4.9 | 8.8 | 173 | 3.2 | 4.8 | |
| Micronesia | 53 | 9.7 | 9.5 | 29 | 10.5 | 11.7 | 24 | 8.8 | 7.8 | |
| Middle Africa | 4 228 | 2.4 | 5.2 | 2 222 | 2.5 | 5.9 | 2 006 | 2.2 | 4.6 | |
| Northern Africa | 11 530 | 4.7 | 5.4 | 5 900 | 4.8 | 5.9 | 5 630 | 4.6 | 5.0 | |
| Northern America | 63 987 | 17.3 | 8.2 | 34 105 | 18.7 | 9.7 | 29 882 | 16.0 | 6.8 | |
| Northern Europe | 33 768 | 31.8 | 11.4 | 17 811 | 33.9 | 13.5 | 15 957 | 29.7 | 9.6 | |
| Polynesia | 60 | 8.8 | 8.4 | 37 | 10.7 | 10.9 | 23 | 6.8 | 6.3 | |
| South America | 52 013 | 12.1 | 8.9 | 26 175 | 12.3 | 10.2 | 25 838 | 11.8 | 7.8 | |
| South-Central Asia | 59 206 | 2.9 | 3.2 | 35 848 | 3.5 | 3.9 | 23 358 | 2.4 | 2.5 | |
| South-Eastern Asia | 57 064 | 8.5 | 7.9 | 32 205 | 9.6 | 10.1 | 24 859 | 7.4 | 6.1 | |
| Southern Africa | 3 943 | 5.8 | 7.2 | 2 052 | 6.2 | 9.1 | 1 891 | 5.5 | 5.9 | |
| Southern Europe | 55 406 | 36.1 | 11.5 | 31 583 | 42.1 | 15.1 | 23 823 | 30.4 | 8.5 | |
| Western Africa | 9 938 | 2.5 | 5.1 | 5 507 | 2.7 | 6.1 | 4 431 | 2.2 | 4.3 | |
| Western Asia | 22 107 | 7.9 | 8.9 | 12 382 | 8.5 | 10.7 | 9 725 | 7.3 | 7.3 | |
| Western Europe | 62 266 | 31.7 | 10.2 | 34 113 | 35.4 | 13.1 | 28 153 | 28.2 | 7.8 | |
GEOGRAPHICAL DISTRIBUTION ACCORDING TO THE WHO CLASSIFICATION
The ASIR for colorectal cancer varied by WHO region. The highest rate was in EURO at 28.8 (36 for men, 23.3 for women), followed by WPRO at 25.3 (30.6 for men, 20.5 for women), PAHO at 20.7 (23.3 for men, 18.5 for women), EMRO at 9 (10.2 for men, 7.9 for women), AFRO at 8.4 (9.5 for men, 7.5 for women), and SEARO at 7 (8.5 for men, 5.5 for women). WPRO had the highest proportion of cases (42.36%), followed by EURO (28.72%), PAHO (16.34%), SEARO (7.35%), AFRO (2.63%), and EMRO (2.61%) (Tab. I).
For ASMR, EURO again had the highest rate at 12 (15.6 for men, 9.3 for women), followed by WPRO at 11.5 (14.3 for men, 9 for women), PAHO at 8.1 (9.4 for men, 7 for women), AFRO at 5.8 (6.7 for men, 5.2 for women), EMRO at 5.1 (5.8 for men, 4.5 for women), and SEARO at 4 (4.9 for men, 3.1 for women). WPRO had the highest proportion of cases (42.36%), followed by EURO (28.16%), PAHO (14.27%), SEARO (8.57%), AFRO (3.65%), and EMRO (2.99%) (Tab. II).
GEOGRAPHICAL DISTRIBUTION IN THE COUNTRIES
The study revealed that China, the United States of America, and Japan had the highest number of new colorectal cancer cases, with 555,477, 155,008, and 148,505 cases, respectively. On the other hand, Sao Tome and Principe, Vanuatu, and Comoros had the lowest number of cases, with 8, 10, and 20 cases, respectively. Furthermore, Hungary (45.3 per 100,000), Slovakia (43.9), and Norway (41.9) had the highest ASIR of colorectal cancer, while Guinea (3.3), The Republic of the Gambia (3.7), and Bhutan (3.8) had the lowest (Tab. S1).
Tab. S1.
Standardized rate of incidence and mortality of Colorectal Cancer in the countries of the world.
| Population | ASIR | ASIR in males | ASIR in females | ASMR | ASMR in males | ASMR in females |
|---|---|---|---|---|---|---|
| Afghanistan | 5.7 | 6.3 | 5.1 | 3.8 | 4.2 | 3.5 |
| Albania | 7.7 | 8.8 | 6.8 | 3.8 | 4.4 | 3.4 |
| Algeria | 15.3 | 16.5 | 14.2 | 8.3 | 9.0 | 7.7 |
| Angola | 7.2 | 9.6 | 5.2 | 5.2 | 7.0 | 3.8 |
| Argentina | 25.1 | 31.0 | 20.6 | 12.6 | 16.3 | 9.9 |
| Armenia | 20.1 | 22.2 | 18.5 | 11.3 | 12.2 | 10.6 |
| Australia | 33.1 | 37.3 | 29.2 | 8.9 | 10.8 | 7.2 |
| Austria | 21.0 | 26.5 | 16.4 | 8.7 | 11.6 | 6.3 |
| Azerbaijan | 14.2 | 17.8 | 11.5 | 8.6 | 11.3 | 6.6 |
| Bahamas | 16.0 | 20.5 | 12.4 | 10.7 | 13.5 | 8.6 |
| Bahrain | 13.9 | 13.7 | 14.6 | 7.1 | 6.8 | 7.5 |
| Bangladesh | 3.8 | 4.2 | 3.3 | 2.3 | 2.6 | 2.0 |
| Barbados | 25.1 | 30.5 | 20.4 | 16.1 | 20.9 | 11.9 |
| Belarus | 30.2 | 39.4 | 24.8 | 14.1 | 19.7 | 10.9 |
| Belgium | 35.3 | 43.6 | 28.0 | 10.0 | 12.6 | 7.8 |
| Belize | 6.2 | 5.9 | 6.6 | 6.0 | 5.3 | 6.6 |
| Benin | 7.7 | 11.3 | 5.0 | 5.7 | 8.5 | 3.7 |
| Bhutan | 3.8 | 5.4 | 1.9 | 2.5 | 3.7 | 1.1 |
| Bolivia, Plurinational State of | 5.7 | 6.3 | 5.1 | 3.4 | 3.9 | 2.9 |
| Bosnia and Herzegovina | 27.0 | 34.6 | 20.8 | 14.5 | 19.6 | 10.5 |
| Botswana | 4.5 | 4.3 | 4.5 | 2.6 | 2.5 | 2.6 |
| Brazil | 19.4 | 21.7 | 17.6 | 9.0 | 10.3 | 7.9 |
| Brunei Darussalam | 34.9 | 42.2 | 27.7 | 14.6 | 18.1 | 11.2 |
| Bulgaria | 27.4 | 36.6 | 20.3 | 14.7 | 20.7 | 10.3 |
| Burkina Faso | 3.8 | 3.6 | 3.8 | 3.1 | 3.0 | 3.1 |
| Burundi | 6.9 | 7.4 | 6.6 | 5.6 | 6.1 | 5.2 |
| Cabo Verde | 8.8 | 12.6 | 7.7 | 3.5 | 5.0 | 3.0 |
| Cambodia | 12.3 | 13.7 | 11.2 | 7.4 | 8.4 | 6.7 |
| Cameroon | 7.1 | 8.0 | 6.4 | 5.2 | 5.9 | 4.6 |
| Canada | 31.2 | 34.7 | 27.9 | 9.9 | 12.0 | 8.0 |
| Central African Republic | 6.5 | 7.2 | 6.0 | 5.4 | 6.1 | 4.9 |
| Chad | 6.9 | 7.9 | 6.0 | 5.7 | 6.5 | 5.0 |
| Chile | 19.9 | 22.6 | 17.7 | 9.4 | 11.0 | 8.1 |
| China | 23.9 | 28.6 | 19.5 | 12.0 | 14.8 | 9.4 |
| Colombia | 16.9 | 17.3 | 16.7 | 8.2 | 8.5 | 7.9 |
| Comoros | 4.5 | 3.7 | 5.2 | 3.0 | 2.3 | 3.7 |
| Congo, Democratic Republic of | 6.7 | 7.1 | 6.3 | 5.1 | 5.5 | 4.8 |
| Congo, Republic of | 6.3 | 6.9 | 5.8 | 4.4 | 5.0 | 4.0 |
| Costa Rica | 17.2 | 17.6 | 16.8 | 9.5 | 10.2 | 8.8 |
| Côte d’Ivoire | ||||||
| Croatia | 36.3 | 50.8 | 24.9 | 19.6 | 28.2 | 13.5 |
| Cuba | 20.1 | 17.9 | 22.0 | 11.3 | 10.7 | 11.8 |
| Cyprus | 24.3 | 35.6 | 14.3 | 10.7 | 14.0 | 7.9 |
| Czechia | 33.7 | 44.4 | 25.2 | 12.3 | 17.0 | 8.6 |
| Denmark | 40.9 | 47.1 | 35.6 | 11.8 | 13.7 | 10.2 |
| Djibouti | 6.9 | 7.8 | 5.9 | 5.3 | 6.1 | 4.6 |
| Dominican Republic | 12.9 | 13.2 | 12.5 | 7.5 | 8.0 | 7.0 |
| Ecuador | 12.9 | 12.5 | 13.2 | 6.4 | 6.4 | 6.3 |
| Egypt | 6.1 | 5.8 | 6.2 | 3.4 | 3.3 | 3.4 |
| El Salvador | 8.5 | 9.5 | 7.7 | 4.5 | 5.1 | 4.1 |
| Equatorial Guinea | 6.9 | 8.3 | 5.5 | 4.8 | 5.7 | 3.9 |
| Eritrea | 7.5 | 8.0 | 7.1 | 5.8 | 6.3 | 5.5 |
| Estonia | 28.3 | 35.6 | 23.9 | 13.8 | 18.6 | 11.1 |
| Eswatini | 4.1 | 4.9 | 3.2 | 3.0 | 3.8 | 2.2 |
| Ethiopia | 8.9 | 9.9 | 8.1 | 6.8 | 7.5 | 6.2 |
| Fiji | 10.9 | 11.7 | 10.3 | 6.8 | 8.1 | 5.9 |
| Finland | 25.7 | 29.4 | 22.8 | 8.8 | 10.9 | 7.2 |
| France | 30.1 | 36.3 | 24.9 | 10.4 | 13.3 | 8.1 |
| Gabon | 7.3 | 8.8 | 5.9 | 4.2 | 5.0 | 3.3 |
| Gaza Strip and West Bank | ||||||
| Georgia | 15.6 | 18.8 | 13.5 | 8.3 | 10.6 | 6.8 |
| Germany | 25.8 | 30.4 | 21.8 | 9.9 | 12.9 | 7.3 |
| Ghana | 3.9 | 4.4 | 3.6 | 2.8 | 3.2 | 2.5 |
| Greece | 26.9 | 34.4 | 20.5 | 10.7 | 14.1 | 7.8 |
| Guatemala | 5.7 | 6.0 | 5.4 | 3.6 | 3.8 | 3.4 |
| Guinea | 3.3 | 3.9 | 2.9 | 2.6 | 3.1 | 2.3 |
| Guinea-Bissau | 4.7 | 5.9 | 3.8 | 3.8 | 4.9 | 3.1 |
| Guyana | 8.5 | 9.4 | 7.5 | 5.0 | 5.8 | 4.3 |
| Haiti | 12.5 | 11.6 | 13.2 | 8.7 | 8.2 | 9.2 |
| Honduras | 8.0 | 8.5 | 7.6 | 4.2 | 4.6 | 3.9 |
| Hungary | 45.3 | 62.0 | 33.1 | 20.2 | 29.0 | 14.0 |
| Iceland | 28.5 | 32.8 | 24.3 | 9.5 | 10.9 | 8.1 |
| India | 4.8 | 6.0 | 3.7 | 2.8 | 3.6 | 2.1 |
| Indonesia | 12.4 | 16.5 | 8.6 | 6.7 | 9.2 | 4.6 |
| Iran, Islamic Republic of | 13.9 | 15.9 | 11.9 | 7.3 | 8.3 | 6.3 |
| Iraq | 8.7 | 10.8 | 6.9 | 5.4 | 6.8 | 4.4 |
| Ireland | 34.9 | 42.6 | 27.9 | 12.4 | 15.7 | 9.4 |
| Israel | 21.9 | 24.5 | 19.8 | 9.0 | 10.3 | 7.9 |
| Italy | 29.3 | 34.2 | 25.2 | 10.1 | 12.7 | 8.1 |
| Jamaica | 21.1 | 26.4 | 16.3 | 13.4 | 17.2 | 9.8 |
| Japan | 38.5 | 47.3 | 30.5 | 11.6 | 14.7 | 8.9 |
| Jordan | 17.7 | 17.2 | 18.4 | 9.6 | 9.7 | 9.6 |
| Kazakhstan | 15.6 | 18.0 | 14.3 | 9.2 | 11.7 | 7.6 |
| Kenya | 10.5 | 11.9 | 9.7 | 7.5 | 8.7 | 6.9 |
| Korea, Democratic Republic of | 18.8 | 22.8 | 15.9 | 10.9 | 13.5 | 8.7 |
| Korea, Republic of | 27.2 | 34.9 | 20.6 | 7.8 | 10.8 | 5.5 |
| Kuwait | 12.5 | 13.1 | 11.9 | 6.6 | 7.0 | 6.1 |
| Kyrgyzstan | 7.8 | 8.8 | 7.0 | 5.4 | 5.9 | 4.9 |
| Lao People’s Democratic Republic | 15.0 | 16.1 | 14.2 | 8.9 | 10.1 | 7.9 |
| Latvia | 36.8 | 48.8 | 30.1 | 12.3 | 15.9 | 10.4 |
| Lebanon | 12.2 | 15.2 | 9.5 | 6.7 | 8.8 | 5.0 |
| Lesotho | 5.3 | 7.8 | 4.0 | 3.8 | 6.0 | 2.8 |
| Liberia | 4.9 | 5.5 | 4.4 | 3.9 | 4.4 | 3.5 |
| Libya | 15.7 | 16.7 | 15.1 | 10.2 | 11.0 | 9.8 |
| Lithuania | 27.6 | 36.4 | 22.3 | 11.7 | 16.1 | 9.4 |
| Luxembourg | 26.3 | 29.7 | 23.7 | 8.7 | 11.2 | 6.4 |
| Madagascar | 6.2 | 5.6 | 6.8 | 4.7 | 4.3 | 5.1 |
| Malawi | 4.9 | 6.3 | 4.1 | 3.9 | 5.0 | 3.3 |
| Malaysia | 19.6 | 21.2 | 18.0 | 10.2 | 11.0 | 9.4 |
| Maldives | 13.0 | 16.4 | 9.3 | 7.4 | 10.5 | 4.1 |
| Mali | 9.2 | 8.8 | 9.6 | 7.5 | 7.2 | 7.7 |
| Malta | 25.7 | 31.1 | 21.2 | 10.1 | 11.9 | 8.6 |
| Mauritania | 7.2 | 8.6 | 6.1 | 5.4 | 6.5 | 4.6 |
| Mauritius | 17.8 | 21.9 | 14.7 | 7.9 | 9.5 | 6.6 |
| Mexico | 10.6 | 12.4 | 9.1 | 5.4 | 6.4 | 4.6 |
| Mongolia | 6.3 | 6.6 | 6.1 | 4.0 | 4.0 | 4.0 |
| Montenegro | 27.4 | 35.2 | 21.1 | 13.7 | 21.5 | 7.8 |
| Morocco | 11.3 | 12.9 | 9.9 | 6.2 | 7.2 | 5.4 |
| Mozambique | 4.1 | 3.6 | 4.4 | 3.2 | 2.8 | 3.5 |
| Myanmar | 9.7 | 11.8 | 8.2 | 5.8 | 7.3 | 4.8 |
| Namibia | 8.2 | 10.8 | 6.4 | 5.8 | 7.6 | 4.4 |
| Nepal | 4.3 | 5.5 | 3.4 | 2.5 | 3.2 | 1.9 |
| New Zealand | 33.8 | 38.3 | 29.7 | 12.3 | 14.5 | 10.3 |
| Nicaragua | 10.5 | 10.4 | 10.5 | 6.0 | 5.8 | 6.0 |
| Niger | 7.0 | 8.0 | 5.9 | 5.8 | 6.6 | 4.9 |
| Nigeria | 7.3 | 8.6 | 6.0 | 5.5 | 6.5 | 4.5 |
| North Macedonia | 26.1 | 26.6 | 26.1 | 13.0 | 13.9 | 12.3 |
| Norway | 41.9 | 45.4 | 38.7 | 13.5 | 15.1 | 12.1 |
| Oman | 9.9 | 11.2 | 7.7 | 5.7 | 6.2 | 4.5 |
| Pakistan | 5.3 | 6.2 | 4.4 | 3.0 | 3.5 | 2.5 |
| Panama | 13.9 | 16.3 | 11.7 | 7.3 | 9.0 | 5.8 |
| Papua New Guinea | 11.3 | 14.5 | 8.4 | 6.9 | 9.2 | 4.8 |
| Paraguay | 18.6 | 20.5 | 16.7 | 9.3 | 10.5 | 8.1 |
| Peru | 11.4 | 11.6 | 11.1 | 5.6 | 5.9 | 5.3 |
| Philippines | 18.8 | 23.7 | 15.1 | 10.1 | 13.4 | 7.8 |
| Poland | 30.5 | 41.7 | 21.9 | 16.1 | 22.8 | 11.3 |
| Portugal | 39.4 | 55.2 | 26.6 | 13.0 | 18.6 | 8.8 |
| Puerto Rico | 26.3 | 32.1 | 22.0 | 12.4 | 15.7 | 9.9 |
| Qatar | 15.7 | 13.6 | 20.6 | 9.0 | 8.0 | 10.9 |
| Republic of Moldova | 30.0 | 44.3 | 19.7 | 17.6 | 26.7 | 11.3 |
| Romania | 30.9 | 41.9 | 22.4 | 14.8 | 21.1 | 10.2 |
| Russian Federation | 27.8 | 34.4 | 23.9 | 13.9 | 18.6 | 11.3 |
| Rwanda | 5.3 | 6.6 | 4.2 | 4.0 | 4.9 | 3.1 |
| Saudi Arabia | 13.9 | 16.1 | 10.9 | 7.3 | 8.7 | 5.6 |
| Senegal | 6.7 | 7.4 | 6.2 | 5.1 | 5.7 | 4.7 |
| Serbia | 33.6 | 46.4 | 22.8 | 16.7 | 23.7 | 11.1 |
| Sierra Leone | 5.0 | 6.0 | 4.1 | 4.1 | 5.0 | 3.3 |
| Singapore | 33.0 | 38.6 | 27.4 | 16.2 | 19.8 | 12.8 |
| Slovakia | 43.9 | 60.7 | 31.1 | 21.0 | 29.6 | 14.8 |
| Slovenia | 39.6 | 55.8 | 25.4 | 11.7 | 16.1 | 8.4 |
| Solomon Islands | 6.7 | 6.5 | 7.0 | 4.2 | 4.9 | 3.5 |
| Somalia | 9.3 | 10.1 | 8.6 | 7.7 | 8.4 | 7.1 |
| South Africa | 14.6 | 17.6 | 12.5 | 7.5 | 9.5 | 6.2 |
| South Sudan | 5.7 | 6.3 | 5.1 | 4.5 | 5.1 | 4.0 |
| Spain | 35.8 | 47.7 | 25.4 | 11.5 | 15.5 | 8.2 |
| Sri Lanka | 7.8 | 7.7 | 7.9 | 3.7 | 3.8 | 3.7 |
| Sudan | 6.3 | 6.6 | 6.0 | 3.9 | 4.2 | 3.6 |
| Suriname | 18.1 | 21.3 | 15.9 | 11.3 | 14.3 | 8.8 |
| Sweden | 27.8 | 30.5 | 25.2 | 10.8 | 12.1 | 9.7 |
| Switzerland | 22.3 | 25.7 | 19.4 | 7.5 | 9.1 | 6.2 |
| Syrian Arab Republic | 12.9 | 14.4 | 11.7 | 8.2 | 9.4 | 7.2 |
| Tajikistan | 4.7 | 6.7 | 2.9 | 3.2 | 4.5 | 2.0 |
| Tanzania, United Republic of | 8.5 | 7.7 | 9.3 | 6.3 | 5.8 | 6.8 |
| Thailand | 16.9 | 19.0 | 15.2 | 8.4 | 9.7 | 7.5 |
| The Netherlands | 41.0 | 48.4 | 34.3 | 13.5 | 16.2 | 11.1 |
| The Republic of the Gambia | ||||||
| Timor-Leste | 8.9 | 10.1 | 7.9 | 5.0 | 6.2 | 4.0 |
| Togo | 8.2 | 12.1 | 5.0 | 6.3 | 9.3 | 3.8 |
| Trinidad and Tobago | 18.5 | 23.0 | 14.7 | 11.0 | 13.7 | 8.8 |
| Tunisia | 12.7 | 14.0 | 11.7 | 6.4 | 7.3 | 5.6 |
| Turkey | 20.6 | 26.2 | 16.2 | 10.1 | 13.0 | 7.8 |
| Turkmenistan | 6.2 | 7.0 | 5.7 | 3.8 | 4.3 | 3.3 |
| Uganda | 6.7 | 7.8 | 6.0 | 5.0 | 5.9 | 4.4 |
| Ukraine | 25.5 | 33.6 | 20.5 | 12.9 | 18.1 | 9.9 |
| United Arab Emirates | 13.1 | 11.5 | 17.3 | 6.9 | 6.2 | 8.7 |
| United Kingdom | 34.1 | 40.0 | 29.0 | 11.4 | 13.5 | 9.6 |
| United States of America | 25.6 | 28.7 | 22.9 | 8.0 | 9.4 | 6.7 |
| Uruguay | 32.0 | 40.6 | 25.6 | 14.3 | 19.3 | 10.9 |
| Uzbekistan | 8.9 | 9.5 | 8.5 | 5.2 | 5.7 | 4.8 |
| Vanuatu | 5.2 | 4.2 | 6.3 | 4.8 | 4.2 | 5.4 |
| Venezuela, Bolivarian Republic of | 14.2 | 15.0 | 13.4 | 7.8 | 8.6 | 7.1 |
| Viet Nam | 14.1 | 17.6 | 11.6 | 7.0 | 9.1 | 5.5 |
| Yemen | 10.7 | 12.0 | 9.5 | 7.7 | 8.6 | 6.9 |
| Zambia | 5.6 | 6.3 | 5.3 | 4.0 | 4.8 | 3.7 |
| Zimbabwe | 8.9 | 10.4 | 8.0 | 6.4 | 7.8 | 5.6 |
When it comes to mortality, China recorded the highest number of colorectal cancer cases (286,162 cases), followed by Japan (59,912 cases), and the United States of America (54,443 cases). Conversely, Sao Tome and Principe (5 cases), Vanuatu (9 cases), and Comoros (13 cases) had the lowest number of cases. Slovakia (21), Hungary (20.2), and Croatia (19.6) had the highest ASMR of colorectal cancer, while Bangladesh (2.3), Bhutan (2.5), and Nepal (2.5) had the lowest (Tab. S2).
Tab. S2.
Human development index and its components for different countries of the world.
| HDI rank | Population | HDI | Life expectancy at birth | Mean years of schooling | Gross national Income (GNI) per capita |
|---|---|---|---|---|---|
| 1 | Norway | 0.96 | 82.40 | 12.90 | 66494 |
| 2 | Switzerland | 0.96 | 83.80 | 13.40 | 69394 |
| 3 | Ireland | 0.96 | 82.30 | 12.70 | 68371 |
| 4 | Germany | 0.95 | 81.30 | 14.20 | 55314 |
| 4 | Iceland | 0.95 | 83.00 | 12.80 | 54682 |
| 7 | Australia | 0.94 | 83.40 | 12.70 | 48085 |
| 7 | Sweden | 0.95 | 82.80 | 12.50 | 54508 |
| 9 | The Netherlands | 0.94 | 82.30 | 12.40 | 57707 |
| 10 | Denmark | 0.94 | 80.90 | 12.60 | 58662 |
| 11 | Finland | 0.94 | 81.90 | 12.80 | 48511 |
| 12 | Singapore | 0.94 | 83.60 | 11.60 | 88155 |
| 13 | Belgium | 0.93 | 81.60 | 12.10 | 52085 |
| 14 | Canada | 0.93 | 82.40 | 13.40 | 48527 |
| 14 | New Zealand | 0.93 | 82.30 | 12.80 | 40799 |
| 14 | United Kingdom | 0.93 | 81.30 | 13.20 | 46071 |
| 17 | United States of America | 0.93 | 78.90 | 13.40 | 63826 |
| 18 | Austria | 0.92 | 81.50 | 12.50 | 56197 |
| 20 | Japan | 0.92 | 84.60 | 12.90 | 42932 |
| 21 | Israel | 0.92 | 83.00 | 13.00 | 40187 |
| 22 | Korea, Republic of | 0.92 | 83.00 | 12.20 | 43044 |
| 23 | Luxembourg | 0.92 | 82.30 | 12.30 | 72712 |
| 24 | Slovenia | 0.92 | 81.30 | 12.70 | 38080 |
| 25 | Spain | 0.90 | 83.60 | 10.30 | 40975 |
| 26 | Czechia | 0.90 | 79.40 | 12.70 | 38109 |
| 26 | France | 0.90 | 82.70 | 11.50 | 47173 |
| 28 | Malta | 0.90 | 82.50 | 11.30 | 39555 |
| 29 | Italy | 0.89 | 83.50 | 10.40 | 42776 |
| 30 | Estonia | 0.89 | 78.80 | 13.10 | 36019 |
| 30 | United Arab Emirates | 0.89 | 78.00 | 12.10 | 67462 |
| 32 | Cyprus | 0.89 | 81.00 | 12.20 | 38207 |
| 33 | Greece | 0.89 | 82.20 | 10.60 | 30155 |
| 34 | Poland | 0.88 | 78.70 | 12.50 | 31623 |
| 35 | Lithuania | 0.88 | 75.90 | 13.10 | 35799 |
| 37 | Latvia | 0.87 | 75.30 | 13.00 | 30282 |
| 38 | Portugal | 0.86 | 82.10 | 9.30 | 33967 |
| 39 | Slovakia | 0.86 | 77.50 | 12.70 | 32113 |
| 40 | Saudi Arabia | 0.85 | 75.10 | 10.20 | 47495 |
| 41 | Bahrain | 0.85 | 77.30 | 9.50 | 42522 |
| 42 | Hungary | 0.85 | 76.90 | 12.00 | 31329 |
| 43 | Chile | 0.85 | 80.20 | 10.60 | 23261 |
| 44 | Croatia | 0.85 | 78.50 | 11.40 | 28070 |
| 45 | Qatar | 0.85 | 80.20 | 9.70 | 92418 |
| 46 | Argentina | 0.85 | 76.70 | 10.90 | 21190 |
| 47 | Brunei Darussalam | 0.84 | 75.90 | 9.10 | 63965 |
| 48 | Montenegro | 0.83 | 76.90 | 11.60 | 21399 |
| 49 | Belarus | 0.82 | 74.80 | 12.30 | 18546 |
| 49 | Romania | 0.83 | 76.10 | 11.10 | 29497 |
| 49 | Russian Federation | 0.82 | 72.60 | 12.20 | 26157 |
| 53 | Kazakhstan | 0.83 | 73.60 | 11.90 | 22857 |
| 54 | Turkey | 0.82 | 77.70 | 8.10 | 27701 |
| 55 | Bulgaria | 0.82 | 75.10 | 11.40 | 23325 |
| 56 | Oman | 0.81 | 77.90 | 9.70 | 25944 |
| 56 | Uruguay | 0.82 | 77.90 | 8.90 | 20064 |
| 58 | Bahamas | 0.81 | 73.90 | 11.40 | 33747 |
| 58 | Panama | 0.82 | 78.50 | 10.20 | 29558 |
| 60 | Barbados | 0.81 | 79.20 | 10.60 | 14936 |
| 61 | Costa Rica | 0.81 | 80.30 | 8.70 | 18486 |
| 62 | Kuwait | 0.81 | 75.50 | 7.30 | 58590 |
| 63 | Georgia | 0.81 | 73.80 | 13.10 | 14429 |
| 63 | Malaysia | 0.81 | 76.20 | 10.40 | 27534 |
| 65 | Serbia | 0.81 | 76.00 | 11.20 | 17192 |
| 66 | Mauritius | 0.80 | 75.00 | 9.50 | 25266 |
| 67 | Trinidad and Tobago | 0.80 | 73.50 | 11.00 | 26231 |
| 68 | Albania | 0.80 | 78.60 | 10.10 | 13998 |
| 70 | Iran, Islamic Republic of | 0.78 | 76.70 | 10.30 | 12447 |
| 71 | Cuba | 0.78 | 78.80 | 11.80 | 8621 |
| 72 | Armenia | 0.78 | 75.10 | 11.30 | 13894 |
| 73 | Sri Lanka | 0.78 | 77.00 | 10.60 | 12707 |
| 76 | Bosnia and Herzegovina | 0.78 | 77.40 | 9.80 | 14872 |
| 76 | Mexico | 0.78 | 75.10 | 8.80 | 19160 |
| 78 | Peru | 0.78 | 76.70 | 9.70 | 12252 |
| 78 | Ukraine | 0.78 | 72.10 | 11.40 | 13216 |
| 80 | Thailand | 0.78 | 77.20 | 7.90 | 17781 |
| 82 | North Macedonia | 0.77 | 75.80 | 9.80 | 15865 |
| 83 | Colombia | 0.77 | 77.30 | 8.50 | 14257 |
| 84 | Brazil | 0.77 | 75.90 | 8.00 | 14263 |
| 84 | Ecuador | 0.76 | 77.00 | 8.90 | 11044 |
| 87 | China | 0.76 | 76.90 | 8.10 | 16057 |
| 88 | Azerbaijan | 0.76 | 73.00 | 10.60 | 13784 |
| 89 | Dominican Republic | 0.76 | 74.10 | 8.10 | 17591 |
| 90 | Lebanon | 0.74 | 78.90 | 8.70 | 14655 |
| 91 | Algeria | 0.75 | 76.90 | 8.00 | 11174 |
| 91 | Republic of Moldova | 0.75 | 71.90 | 11.70 | 13664 |
| 93 | Fiji | 0.74 | 67.40 | 10.90 | 13009 |
| 94 | Tunisia | 0.74 | 76.70 | 7.20 | 10414 |
| 97 | Mongolia | 0.74 | 69.90 | 10.30 | 10839 |
| 98 | Jamaica | 0.73 | 74.50 | 9.70 | 9319 |
| 98 | Maldives | 0.74 | 78.90 | 7.00 | 17417 |
| 98 | Suriname | 0.74 | 71.70 | 9.30 | 14324 |
| 101 | Venezuela, Bolivarian Republic of | 0.71 | 72.10 | 10.30 | 7045 |
| 102 | Botswana | 0.74 | 69.60 | 9.60 | 16437 |
| 103 | Jordan | 0.73 | 74.50 | 10.50 | 9858 |
| 104 | Paraguay | 0.73 | 74.30 | 8.50 | 12224 |
| 106 | Libya | 0.72 | 72.90 | 7.60 | 15688 |
| 107 | Uzbekistan | 0.72 | 71.70 | 11.80 | 7142 |
| 108 | Belize | 0.72 | 74.60 | 9.90 | 6382 |
| 108 | Bolivia, Plurinational State of | 0.72 | 71.50 | 9.00 | 8554 |
| 110 | Indonesia | 0.72 | 71.70 | 8.20 | 11459 |
| 111 | Philippines | 0.72 | 71.20 | 9.40 | 9778 |
| 112 | Turkmenistan | 0.72 | 68.20 | 10.30 | 14909 |
| 114 | Gaza Strip and West Bank | 0.71 | 74.10 | 9.20 | 6417 |
| 115 | South Africa | 0.71 | 64.10 | 10.20 | 12129 |
| 117 | Egypt | 0.71 | 72.00 | 7.40 | 11466 |
| 118 | Viet Nam | 0.70 | 75.40 | 8.30 | 7433 |
| 119 | Gabon | 0.70 | 66.50 | 8.70 | 13930 |
| 120 | Kyrgyzstan | 0.70 | 71.50 | 11.10 | 4864 |
| 121 | Guyana | 0.68 | 69.90 | 8.50 | 9455 |
| 121 | Morocco | 0.69 | 76.70 | 5.60 | 7368 |
| 123 | Iraq | 0.67 | 70.60 | 7.30 | 10801 |
| 124 | El Salvador | 0.67 | 73.30 | 6.90 | 8359 |
| 125 | Cabo Verde | 0.67 | 73.00 | 6.30 | 7019 |
| 126 | Tajikistan | 0.67 | 71.10 | 10.70 | 3954 |
| 127 | Nicaragua | 0.66 | 74.50 | 6.90 | 5284 |
| 128 | Guatemala | 0.66 | 74.30 | 6.60 | 8494 |
| 129 | Namibia | 0.65 | 63.70 | 7.00 | 9357 |
| 130 | India | 0.65 | 69.70 | 6.50 | 6681 |
| 131 | Bhutan | 0.65 | 71.80 | 4.10 | 10746 |
| 132 | Honduras | 0.63 | 75.30 | 6.60 | 5308 |
| 134 | Bangladesh | 0.63 | 72.60 | 6.20 | 4976 |
| 137 | Lao People’s Democratic Republic | 0.61 | 67.90 | 5.30 | 7413 |
| 138 | Ghana | 0.61 | 64.10 | 7.30 | 5269 |
| 139 | Eswatini | 0.61 | 60.20 | 6.90 | 7919 |
| 140 | Vanuatu | 0.61 | 70.50 | 7.10 | 3105 |
| 141 | Kenya | 0.60 | 66.70 | 6.60 | 4244 |
| 141 | Timor-Leste | 0.61 | 69.50 | 4.80 | 4440 |
| 143 | Nepal | 0.60 | 70.80 | 5.00 | 3457 |
| 144 | Cambodia | 0.59 | 69.80 | 5.00 | 4246 |
| 145 | Angola | 0.58 | 61.20 | 5.20 | 6104 |
| 145 | Equatorial Guinea | 0.59 | 58.70 | 5.90 | 13944 |
| 145 | Zambia | 0.58 | 63.90 | 7.20 | 3326 |
| 148 | Myanmar | 0.58 | 67.10 | 5.00 | 4961 |
| 149 | Congo, Republic of | 0.57 | 64.60 | 6.50 | 2879 |
| 150 | Zimbabwe | 0.57 | 61.50 | 8.50 | 2666 |
| 151 | Solomon Islands | 0.57 | 73.00 | 5.70 | 2253 |
| 152 | Syrian Arab Republic | 0.57 | 72.70 | 5.10 | 3613 |
| 153 | Cameroon | 0.56 | 59.30 | 6.30 | 3581 |
| 154 | Comoros | 0.55 | 64.30 | 5.10 | 3099 |
| 154 | Pakistan | 0.56 | 67.30 | 5.20 | 5005 |
| 156 | Papua New Guinea | 0.56 | 64.50 | 4.70 | 4301 |
| 157 | Mauritania | 0.55 | 64.90 | 4.70 | 5135 |
| 158 | Benin | 0.55 | 61.80 | 3.80 | 3254 |
| 159 | Rwanda | 0.54 | 69.00 | 4.40 | 2155 |
| 160 | Uganda | 0.54 | 63.40 | 6.20 | 2123 |
| 161 | Côte d’Ivoire | 0.54 | 57.80 | 5.30 | 5069 |
| 161 | Nigeria | 0.54 | 54.70 | 6.70 | 4910 |
| 163 | Madagascar | 0.53 | 67.00 | 6.10 | 1596 |
| 164 | Tanzania, United Republic of | 0.53 | 65.50 | 6.10 | 2600 |
| 165 | Lesotho | 0.53 | 54.30 | 6.50 | 3151 |
| 166 | Djibouti | 0.52 | 67.10 | 4.10 | 5689 |
| 167 | Senegal | 0.51 | 67.90 | 3.20 | 3309 |
| 168 | Togo | 0.52 | 61.00 | 4.90 | 1602 |
| 169 | Afghanistan | 0.51 | 64.80 | 3.90 | 2229 |
| 170 | Haiti | 0.51 | 64.00 | 5.60 | 1709 |
| 171 | Sudan | 0.51 | 65.30 | 3.80 | 3829 |
| 172 | The Republic of the Gambia | 0.50 | 62.10 | 3.90 | 2168 |
| 173 | Liberia | 0.48 | 64.10 | 4.80 | 1258 |
| 174 | Congo, Democratic Republic of | 0.48 | 60.70 | 6.80 | 1063 |
| 174 | Ethiopia | 0.49 | 66.60 | 2.90 | 2207 |
| 174 | Malawi | 0.48 | 64.30 | 4.70 | 1035 |
| 177 | Guinea | 0.48 | 61.60 | 2.80 | 2405 |
| 178 | Guinea-Bissau | 0.48 | 58.30 | 3.60 | 1996 |
| 179 | Yemen | 0.47 | 66.10 | 3.20 | 1594 |
| 180 | Eritrea | 0.46 | 66.30 | 3.90 | 2793 |
| 181 | Mozambique | 0.46 | 60.90 | 3.50 | 1250 |
| 182 | Sierra Leone | 0.45 | 54.70 | 3.70 | 1668 |
| 183 | Burkina Faso | 0.45 | 61.60 | 1.60 | 2133 |
| 184 | Burundi | 0.43 | 61.60 | 3.30 | 754 |
| 184 | Mali | 0.43 | 59.30 | 2.40 | 2269 |
| 186 | South Sudan | 0.43 | 57.90 | 4.80 | 2003 |
| 187 | Chad | 0.40 | 54.20 | 2.50 | 1555 |
| 188 | Central African Republic | 0.40 | 53.30 | 4.30 | 993 |
| 189 | Niger | 0.39 | 62.40 | 2.10 | 1201 |
ASIR and ASMR
Globally, there was a statistically significant positive correlation of 0.895 (p ≤ 0.001) between the ASIR and ASMR of colorectal cancer.
ASIR and HDI
Analysis revealed a significant positive correlation of 0.794 (p ≤ 0.001) between the ASIR of colorectal cancer and the HDI. Furthermore, positive correlations emerged between the ASIR and specific HDI dimensions. Namely, the ASIR correlated positively with life expectancy at birth (0.724, p ≤ 0.001), education levels (0.743, p ≤ 0.001), and income per capita (0.706, p ≤ 0.001) (Tabs. III, S1, S2).
Tab. III.
The relationship between the incidence and mortality of Colorectal Cancer with the HDI and its components.
| Incidence and mortality rates | HDI | Life expectancy at birth | Mean years of schooling | Gross national Income (GNI) per capita | ||
|---|---|---|---|---|---|---|
| ASIR | Boys | r | 0.757 | 0.677 | 0.715 | 0.652 |
| p-value | 0.001 | 0.001 | 0.001 | 0.001 | ||
| Girls | r | 0.811 | 0.749 | 0.757 | 0.749 | |
| p-value | 0.001 | 0.001 | 0.001 | 0.001 | ||
| Total | r | 0.794 | 0.724 | 0.743 | 0.706 | |
| p-value | 0.001 | 0.001 | 0.001 | 0.001 | ||
| ASMR | Boys | r | 0.604 | 0.519 | 0.606 | 0.459 |
| p-value | 0.001 | 0.001 | 0.001 | 0.001 | ||
| Girls | r | 0.626 | 0.575 | 0.620 | 0.535 | |
| p-value | 0.001 | 0.001 | 0.001 | 0.001 | ||
| Total | r | 0.638 | 0.569 | 0.631 | 0.512 | |
| p-value | 0.001 | 0.001 | 0.001 | 0.001 | ||
ASMR and HDI
The ASMR for colorectal cancer showed a significant positive correlation of 0.638 with the HDI (p = 0.001). Positive correlations were also found between the ASMR and life expectancy at birth (0.569, p ≤ 0.001), education levels (0.631, p ≤ 0.001), and income per capita (0.512, p ≤ 0.001) (Tabs. III, S1, S2).
Discussion
This comprehensive analysis reveals stark global disparities in colorectal cancer incidence and mortality, underscoring the impact of geographic differences and human development levels. With over 1.9 million new cases and 0.9 million deaths in 2020, the data highlights the considerable worldwide burden of this disease.
Geographically, incidence and mortality rates varied greatly by continent. Europe had the highest age-standardized rates while Africa had the lowest, likely reflecting disparities in risk factors, genetics, and screening access [21]. Rates also differed by WHO region, with EURO and WPRO having the highest burdens and EMRO, AFRO, and SEARO the lowest. These regional variances further emphasize how geographic factors influence colorectal cancer outcomes.
When observing the data at a country level, the highest number of new colorectal cases were recorded in China, United States, and Japan, while the lowest were in Sao Tome and Principe, Vanuatu, and Comoros. Interestingly, Hungary, Slovakia, and Norway had the highest ASIR, while Guinea, The Republic of Gambia, and Bhutan had the lowest. This discrepancy between the number of cases and ASIR can be attributed to the differences in population sizes, healthcare infrastructure, and cancer surveillance among these countries [2].
A significant positive correlation was found between global colorectal cancer ASIR and ASMR, suggesting that rising incidence rates are often paired with increasing mortality burdens [22, 23].This pattern indicates that many regions lack adequate early detection and treatment access needed to reduce colorectal cancer mortality despite rising incidence levels. Improving screening programs and treatment availability, particularly in less developed areas, is critical to curb worldwide colorectal cancer mortality rates and mitigate the impact of increasing incidence.
The study also found positive correlations between colorectal cancer’s standardized incidence and mortality rates and various HDI dimensions, including life expectancy at birth, education levels, and income. This indicates that higher human development is linked to greater colorectal cancer incidence and mortality, possibly due to several factors. These include increased life expectancy resulting in more cases among older populations, dietary and lifestyle changes accompanying development, and improved detection enabled by advanced healthcare systems [24]. This complex relationship between development and colorectal cancer epidemiology highlights the need for multifaceted control strategies encompassing prevention, screening, treatment, and research.
As noted in previous research, men consistently exhibited higher colorectal cancer incidence and mortality rates than women across all global regions analyzed [4, 12, 13, 18-20]. This sex disparity highlights the need for targeted strategies that take into account differences in risk factors, screening behaviors, treatment access, and outcomes between males and females. Gender-specific prevention and control initiatives should be considered to equitably address the worldwide colorectal cancer burden for both sexes.
These disparities could be attributed to a variety of factors, including differences in dietary habits, healthcare infrastructure, access to screening programs, and prevalence of risk factors such as smoking and obesity. For example, higher rates in developed regions might reflect better detection and reporting mechanisms, as well as lifestyle factors such as diet and physical inactivity. Conversely, lower rates in less developed regions could indicate underreporting and limited access to healthcare services [25-28].
Moreover, the observed positive correlation between the Human Development Index (HDI) and colorectal cancer incidence and mortality underscores the impact of socioeconomic factors on health outcomes. Countries with higher HDI tend to have better healthcare systems and more widespread use of screening programs, which can lead to higher detection rates. However, these same countries also exhibit lifestyle factors that increase colorectal cancer risk, such as higher consumption of red and processed meats.
It is also crucial to address potential data quality issues in the GLOBOCAN database. Variations in data collection methods, reporting accuracy, and completeness can affect the reliability of the reported incidence and mortality rates [14]. For instance, underreporting in low-income countries may lead to an underestimation of the true burden of colorectal cancer in these regions. The GLOBOCAN database relies on a combination of cancer registry data, vital statistics, and modeling techniques to estimate cancer incidence and mortality. While this approach allows for comprehensive global estimates, it also introduces potential sources of error [2, 12-14, 29].
This global analysis provides valuable insights into the varying colorectal cancer incidence and mortality rates across countries and regions. The findings can help guide targeted prevention and treatment initiatives tailored to local contexts. Further research should delve deeper into the specific factors driving regional disparities worldwide to inform more effective, context-specific strategies for combating colorectal cancer.
Overall, the results underscore the urgent need for an integrated global approach that accounts for regional differences in colorectal cancer epidemiology, socioeconomic conditions, and local healthcare capacity. Only through coordinated global action can we hope to confront the rising worldwide burden of colorectal cancer. Moving forward, global collaboration and resource mobilization focused on prevention, early detection, treatment access, research, and health system strengthening will be essential to equitably and sustainably reduce the threat posed by this disease worldwide.
LIMITATIONS OF THE STUDY
The quality of cancer data in GLOBOCAN varies, especially for medium or low HDI countries. Thus, estimates for some countries may rely on limited regional cancer recordings or be extrapolated from neighboring countries [29]. See Table S1, Tables I and II for further details on data quality issues across countries.
Conclusions
In conclusion, this study provides valuable insights into the global disparities in colorectal cancer incidence and mortality rates. It underscores the need for comprehensive strategies to reduce colorectal cancer burden, particularly in regions and countries with high incidence and mortality rates. Such strategies should include improving access to early detection and treatment, promoting lifestyle changes, and strengthening cancer surveillance systems.
Acknowledgments
This is to acknowledge that the project leading to the publication of this paper is fully funded by the research deputy of Shahrekord University of Medical Sciences in Iran with grant number: 7026 and ethical code: IR.SKUMS.REC.1402.124.
Data availability
The data used in this study can be retrieved in the tables provided in the text of the article. In addition, the data used in the present study is freely available in the globocan website (https://gco.iarc.fr/).
Conflicts of interest statement
There is no conflict of interest in this study.
Funding source
This work was supported by the research deputy of Shahrekord University of Medical Sciences in Iran with grant number: 7026 and ethical code: IR.SKUMS.REC.1402.124.
Author’s contributions
DD: Data curation, writing-original draft, preparation, reviewing, editing, methodology, and software. AMH: Data curation, writing-original draft, preparation, visualization, investigation, project administration, validation, reviewing, editing, methodology, and software. SK: Conceptualization, writing-original draft, and investigation.
History
Received on August 22, 2023. Accepted on August 19, 2024.
Figures and tables
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data used in this study can be retrieved in the tables provided in the text of the article. In addition, the data used in the present study is freely available in the globocan website (https://gco.iarc.fr/).