Supplementary Material for: Disease burden of colorectal cancer in China from 1990 to 2019: Age and sex-specific time trends and 10-year forecast

Introduction: Colorectal cancer (CRC) is the third most prevalent malignant tumor worldwide and the second leading cause of cancer-related death.Aimed to report the disease burden of CRC in China from 1990 to 2019 and predict the trend of mortality burden over the next 10 years. Methods: The age-period-cohort (APC) model was implemented to analyze the trends of mortality from CRC in China from 1990 to 2019, and the autoregressive integrated moving average (ARIMA) model was used to predict the trends of CRC incidence and mortality from 2020 to 2029. Results: From 1990 to 2019, the incidence of CRC in China increased from 105,911 cases (95% uncertainty interval (UI): 93,808-119,021) to 607,900 cases (95% UI: 521,805-708,420). The age-standardized incidence rate (ASIR) increased from 12.52 per 100,000 (95% UI: 11.15-14.03) to 30.55 per 100,000 (95% UI: 26.37-35.5), with an estimated annual percentage change (EAPC) of 3.66 (95% confidence interval (CI): 3.37-3.95), showing an upward trend. The age-standardized mortality rate (ASMR) increased from 10.18 per 100,000 (95% UI: 9.03-11.37) to 13.86 per 100,000 (95% UI: 11.92-16.01), with an EAPC of 1.39 (95% CI: 1.14-1.63), also showing an upward trend. The age group with the highest incidence and mortality in 2019 was 65-69 years old for both sexes, and the age group with the highest mortality was 70-74 years old. Males had higher relative risks of incidence and mortality than females. Low-calcium diet was the risk factor for both sexes and females alone in 1990, while low-milk diet was the risk factor in 2019; however, smoking remained the risk factor for males. The ARIMA model predicted an increase in both disease and mortality burden of CRC over the next 10 years. Conclusion: The disease and mortality burden of CRC in China showed an overall upward trend from 1990 to 2019, with higher burden in males than females, and the situation remains extremely severe in the next decade