A comparative analysis of colorectal cancer in high-income North America vs Asian subregions: Temporal trends, age patterns, gender and risk-factor disparities using GBD 2021.

84 Background: Colorectal cancer (CRC) burdens vary across North America and Asia due to screening, diet, and metabolic risks. We contrasted temporal trends, age-sex patterns, and risk-factor disparities. Methods: Data were obtained using the Institute for Health Metrics and Evaluation Global Burden of Disease (GBD) 2021 Results Tool.Trends were summarized with estimated annual percentage change (EAPC, 1990–2021). Age-standardized incidence (ASIR), death, and DALY rates were analyzed by region/subregion and sex. Age-stratified crude mortality and DALYs identified high-burden subgroups. Risk attribution was assessed using DALY percentages and temporal risk-factor (RF) rankings from 1990 to 2021. Statistics were performed in Microsoft Excel. Results: ASIR declined in High-Income North America (HI-NA; EAPC −0.80%/y) but rose in East Asia (+1.75%/y), Southeast Asia (+1.45%/y), South Asia (+0.46%/y), and High-Income Asia-Pacific (HI-AP; +0.33%/y); Central Asia was ~stable (−0.15%/y). Age patterns: male incidence exceeded female through most ages, with female incidence/deaths surpassing in the oldest groups. Examples: HI-NA incidence peaks: males 70–74y (20,275.87), females ≥85y (18,583.52); deaths peak at ≥85y (males 7,584.57; females 11,963.02). HI-AP shows analogous late-life peaks (male ≥85y deaths 10,729.30; female ≥85y 19,288.32). South Asia uniquely shows female-higher incidence/deaths at 15–59y, reversing after 60y. Southeast and Central Asia display male-higher burdens to ~75–79y, with female predominance ≥80y; East Asia has male-higher across ages but similar age-peak structure by sex. Across regions, the largest gender disparity in attributable burden is consistently seen in diet low in milk. Processed/red meat burdens are highest in HI-NA (12.09; 16.21) and substantial in East Asia (red meat 15.80). Diet low in calcium is highest in Southeast Asia (26.07). High BMI shows minimal sex disparity in HI-NA/HI-AP; alcohol disparity is slightly greater in East Asia. Conclusions: CRC incidence is falling in HI-NA but rising across Asia,fastest in East and Southeast Asia, with late-life female predominance in several regions. Prevention priorities include boosting calcium/dairy access in Asia, reducing red/processed meat in HI-NA, and risk-adapted screening that anticipates rapid Asian increase. ASIR (per 100,000) by region and year; EAPC 1990–2021 (both sexes). Region 1990 2000 2010 2021 EAPC (%/y) High-Income North America 47.34 49.08 43.70 38.75 −0.80 High-Income Asia-Pacific 39.72 44.15 45.68 44.89 +0.33 East Asia 19.08 20.94 25.89 31.60 +1.75 Southeast Asia 11.28 13.34 15.66 17.70 +1.45 Central Asia 12.90 10.38 10.88 10.82 −0.15 South Asia 4.69 4.86 4.86 5.65 +0.46