The Escalating Burden of Early-Onset Colorectal Cancer Mortality in Brazil: A 24-Year Nationwide Analysis of Regional Disparities and the Epidemiological Transition (2000-2023)

PURPOSE Global early-onset colorectal cancer (EO-CRC) mortality is rising among young adults, yet long-term surveillance data from large transitioning nations remains scarce. This study evaluated 24-year temporal trends and regional disparities in mortality among adults aged 20-49 years in Brazil to inform public health policy, analyze lifestyle-driven shifts, and address persistent healthcare inequities across distinct socioeconomic macro-regions within the vast Brazilian territory. METHODS This retrospective population-based study utilized nationwide mortality data from the Brazilian Unified Health System (DATASUS) and 2024 population projections (IBGE). EO-CRC deaths (ICD-10: C18-C20) in adults aged 20-49 were analyzed across the five macro-regions from 2000 to 2023. Age-specific mortality rates (ASMR) per 100,000 inhabitants and percentage changes (PC) were calculated to assess the impact of the epidemiological transition. RESULTS From 2000 to 2023, absolute annual EO-CRC deaths surged 115.8% (1,094 to 2,361), while national ASMR rose 71.3% (1.43 to 2.45/100,000). Although South (3.30) and Southeast (2.73) regions maintained the highest rates, regional divergence was stark: Northeast mortality skyrocketed 179.1% (0.63 to 1.77/100,000), followed by the North (+121.9%; 0.75 to 1.66). Conversely, the high-resource Southeast grew slowest (+54.1%), suggesting saturation of current prevention models in urbanized areas. The disparity gap between South and North narrowed from 2.7-fold in 2000 to a 2.0-fold in 2023, signaling national convergence toward a higher disease burden. Notably, the North's 2023 mortality rate matches levels seen in developed regions over a decade ago, representing a significant developmental lag and delayed access to diagnostic infrastructure. Furthermore, a 4.1% decline in 2020 recorded deaths likely reflects pandemic-related underreporting, particularly affecting mortality surveillance efficiency. CONCLUSION Brazil faces a rapid, unequal escalation of EO-CRC mortality affecting the young working-age population. As this population falls below current standard screening guidelines, these findings highlight a critical “screening gap.” Urgent intervention is required to improve diagnostic pathways, clinical awareness, and symptom recognition for young adults in Low- and Middle-Income Countries (LMICs), effectively and swiftly mitigating the rising toll of this preventable disease in rapidly transitioning societies undergoing profound demographic shifts and lifestyle changes driven by increasing urbanization and Westernized dietary habits across Brazil.