Incidence, prevalence, and temporal trends of colorectal cancer across age, sex, race, and ethnicity: A large real-world analysis.

e15699 Background: Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality in the United States. Recent epidemiologic data suggest rising CRC incidence among younger adults and persistent disparities across demographic groups. Using a large real-world database, we evaluated temporal trends in CRC incidence and prevalence from 2020 to 2024. Methods: We conducted a retrospective observational study using the TriNetX Global Collaborative Network, comprising data from 166 healthcare organizations and approximately 188 million patients. CRC cases were identified using ICD-10-CM codes C18–C20. Annual incidence proportion, prevalence, and incidence rates (cases per person-day) were calculated and stratified by age, sex, race, and ethnicity. Results: From 2020 to 2024, CRC incidence and prevalence increased steadily across all demographic groups. Overall incidence proportion rose from approximately 0.03% to 0.045–0.05%, while prevalence increased from roughly 0.10% to 0.14–0.16%. Incidence rates nearly doubled over the study period. CRC burden increased markedly with age, with the highest incidence rates observed among individuals aged ≥70 years. Although absolute rates remained low, adults aged 20–39 years demonstrated relative increases in incidence over time. Males consistently exhibited higher incidence and prevalence than females. Racial disparities persisted, with increasing incidence among Black, White, and Asian patients, and the highest prevalence observed in patients with unknown race. Conclusions: In this large real-world analysis, CRC incidence and prevalence increased steadily from 2020 to 2024 across all demographic groups. Rising incidence among younger adults, alongside persistent sex- and race-based disparities, underscores the need for equitable, risk-adapted screening strategies and improved access to preventive care.