Colorectal Cancer Mortality in Brazil: Sex and Racial Inequalities in a Nationwide Ecological Study

PURPOSE Colorectal cancer (CRC) is among the most prevalent malignancies worldwide, representing a growing public health challenge due to its increasing incidence and mortality. In Brazil, demographic disparities in CRC outcomes remain insufficiently characterized. Therefore, this study aimed to describe sex- and race-related patterns in CRC mortality in Brazil and compare them with demographic distributions. METHODS A nationwide descriptive ecological study was conducted using mortality data from the Brazilian Mortality Information System (SIM/DATASUS), considering deaths by place of residence between 2015 and 2024. Cases were identified according to ICD-10 codes C18 to C20. Demographic data regarding sex and race/skin color distribution were obtained from the 2022 Brazilian Demographic Census, while national incidence estimates were retrieved from the Brazilian National Cancer Institute (INCA). A descriptive analysis comparing mortality distribution and population composition was performed. RESULTS A total of 200,614 CRC-related deaths were identified. Mortality was similarly distributed between sexes, with 100,441 deaths among women (50.07%) and 100,161 among men (49.93%). According to the 2022 Census, women represented 51.5% of the Brazilian population and men 48.5%. Women also had higher estimated annual incidence for the 2023–2025 triennium, with approximately 23,660 new cases annually compared to 21,970 among men. Regarding race/skin color, White individuals accounted for 62.49% of CRC deaths despite representing 43.5% of the Brazilian population. In contrast, Pardo individuals represented 27.47% of deaths while comprising 45.3% of the population. Black individuals accounted for 6.55% of deaths and 10.2% of the population, while Indigenous individuals represented 0.1% of deaths and 0.8% of the population. CONCLUSION The discrepancies between mortality distribution and demographic composition highlight the complexity of interpreting CRC outcomes in Brazil. The disproportionate mortality burden among White individuals may reflect demographic aging, differences in healthcare access, diagnostic patterns, or variations in CRC incidence across racial groups. However, the absence of nationally stratified incidence data by race limits accurate assessment of mortality risk and outcome disparities. These findings reinforce the need for more comprehensive epidemiological surveillance integrating incidence, stage at diagnosis, and treatment access according to racial and demographic characteristics in Brazil.