(2022) 22:1896 Pan et al BMC Public Health https://doi.org/10.1186/s12889-022-14274-7 Open Access RESEARCH The global, regional, and national early‑onset colorectal cancer burden and trends from 1990 to 2019: results from the Global Burden of Disease Study 2019 Hongfeng Pan1,2†, Zeyi Zhao1,2†, Yu Deng1,2†, Zhifang Zheng1,2, Ying Huang1,2*, Shenghui Huang1,2* and Pan Chi1,2* Abstract Purpose: The incidence of early-onset colorectal cancer (EO-CRC), which occurs in people under age 50, has been increasing annually The aim of this study was to provide an up-to-date estimate of the global EO-CRC burden Methods: We used Global Burden of Disease Study data and methodologies to describe changes in the EO-CRC burden from 1990 to 2019, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs) The driving factors for cancer burden variation were further analyzed using decomposition analysis Frontier analysis was used to visually demonstrate the potential for burden reduction in each country or region based on their development levels Results: The global EO-CRC incidence more than doubled, increasing from 95,737 (95% uncertainty interval (UI): 90,838–101.042) /100,000 in 1990 to 226,782 (95% UI: 207,495–248,604) /100,000 in 2019 Additionally, related deaths increased from 50,997 (95% UI: 47,692–54,410) /100,000 to 87,014 (95% UI: 80,259–94,339) /100,000, and DALYs increased from 256,1842 (95% UI: 239,4962–2,735,823) /100,000 to 4,297,573 (95% UI: 3,965,485–4,650,790) /100,000 Regarding age-standardized rates, incidence and prevalence increased significantly, while mortality and DALYs rate were basically unchanged Decomposition analysis showed a significant increase in DALYs in the middle sociodemographic index (SDI) quintile region, in which aging and population growth played a major driving role Frontier analysis showed that countries or regions with a higher SDI quintile tend to have greater improvement potential Conclusion: The current EO-CRC burden was found to be the greatest in the high-middle SDI quintile region and East Asia, which may need to adjust screening guidelines accordingly and introduce more effective interventions Keywords: Early-onset colorectal cancer (EO-CRC), Incidence, Prevalence, Mortality, Disability-adjusted life years (DALYs), Global Burden of Disease (GBD) † Hongfeng Pan, Zeyi Zhao and Yu Deng contributed equally to this work and should be considered co-first authors *Correspondence: fuzhouwushan@foxmail.com; shepherd819@163.com; chipan363@163.com Department of Colorectal Surgery Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian Province, China Full list of author information is available at the end of the article Introduction In 2019, colorectal cancer became the third most common cause of cancer deaths worldwide and the second leading cause of cancer-related disability-adjusted life years (DALYs) [1] Early-onset colorectal cancer (EOCRC) is defined as colorectal cancer diagnosed before the age of 50 and is reported that it accounts for about © The Author(s) 2022 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data Pan et al BMC Public Health (2022) 22:1896 10–12% of newly diagnosed colorectal cancer [2, 3] Currently, around 50 is also the recommended age to start most screening programs, according to analyses of the cost-effectiveness for the sustainability of healthcare systems [4] Although in many developed countries, the incidence of colorectal cancer in people above age 50 shows a stable or slightly decreasing trend, in recent decades, the incidence of EO-CRC has shown a continuous increasing trend in many countries, such as Australia, Canada, Denmark, and nine others [3, 5] Based on previous longterm data, this upward trend dates back to the 1990s, at the earliest It should be noted that studies have shown that the EO-CRC mortality rate is increasing annually, though it is decreasing in people over the age of 50 [6] However, on the one hand, the reasons for the increasing incidence of EO-CRC have not been determined, and on the other hand, there is no reasonable explanation for why EO-CRC is often advanced and poorly differentiated when diagnosed [7] Several findings suggest that many well recognized colorectal cancer risk factors, such as lifestyle westernization and tobacco and alcohol use, among others, play important roles in EO-CRC [8–11] Some scholars believe that geographical and sociodemographic factors such as ethnicity and income are also associated with epidemiological changes in EO-CRC Moreover, with the expansion of screening programs and the popularization of colonoscopy, the worldwide EOCRC burden has changed dramatically [12, 13] In conclusion, the global EO-CRC burden is ominous, and effective use of limited health resources requires an understanding of burden variance over time and across geographical locations as well as different factors’ roles in these changes This study aimed to provide the latest estimates of the EO-CRC burden in 204 countries and regions worldwide The relationship between the level of sociodemographic development and the EO-CRC burden was also studied Finally, potential improvements in the EO-CRC burden were analyzed to identify those countries or regions where more work is needed Methods Study population and data collection The Global Burden of Disease (GBD) Study 2019 comprehensively assessed health loss in 204 countries and territories using the latest epidemiological data sources and improved standardized methods and found that health loss was caused by 369 diseases and injuries and 87 risk factors In the present study, we obtained and analyzed GBD Study data on EO-CRC incidence, prevalence, mortality, and DALYs (