Secular trend of colorectal cancer attributable to low physical activity from 1990 to 2021 in China

doi:10.21203/rs.3.rs-4861987/v1

Download PDF

Research Article

Secular trend of colorectal cancer attributable to low physical activity from 1990 to 2021 in China

https://doi.org/10.21203/rs.3.rs-4861987/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Objective

This study aims to report low physical activity related colorectal cancer (LPARCC) death and Disability Adjusted Life Years (DALYs) in 1990–2021, and decompose the changes in disease burden into population growth, population aging, and epidemiological changes.

Methods

We obtained LPARCC data from the Global Burden of Disease (GBD) online database. The Joinpoint regression model and the age-period-cohort model (APC) were used to describe the trend of disease burden and analyzed the effects of age, period, and cohort. Finally, a recently developed decomposition method was conducted to attribute changes in the burden of disease from 1990 to 2021 to population growth, population aging, and epidemiological changes.

Results

From 1990 to 2021, there were significant increased trends in all ages and age-standardized rates of summary exposure values of low physical activity, with percentage changes of 0.46 (95% CI: 0.16 to 0.86) and 0.16 (95% CI: -0.08 to 0.45), respectively. The percentage change of age-standardized mortality rates (ASMR) for LPARCC from 1990 to 2021 was − 0.07 (95% CI: -0.38–0.37) and percentage change of age-standardized DALY rate (ASDR) was − 0.09 (95% CI: -0.37–0.33), both of them showed non-significantly decreased trends. In addition, the results of the Joinpoint regression model demonstrated that the annual percentage changes in ASMR and ASDR rates for LPARCC were − 0.22 (95% CI: -0.52–0.09) and − 0.29 (95% CI: -0.55– -0.03), respectively. Finally, from 1990 to 2021, the ASMR of LPARCC increased by 191.19%, which could be decomposed into age structure (170.62%), mortality change in low physical activity (-15.42%), and population size (35.99%), respectively.

Conclusion

Over the past 30 years, the number of LPARCC death and DALYs in China had shown an upward trend, which was mainly attributed to population aging.

colorectal cancer

low physical activity

temporal trends

decomposition analysis

In 2016, data from the Chinese Cancer Registry reported that colorectal cancer is the second most common cancer and the forth leading cause of cancer deaths. It is estimated that there were about 408 000 cases and 195 600 deaths of colorectal cancer in China in 2016 [1]. Evidence from prospective cohort and meta-analyses studies have supported that modifiable behavioral factors such as smoking [2], alcohol consumption [3], low physical activity [4, 5], high body mass index (BMI) [6–8], and unhealthy eating habits [9, 10] are risk factors for colorectal cancer. Therefore, primary prevention measures such as smoking cessation, alcohol restriction, healthy diets have important public health significance for reducing disease burden of colorectal cancer and deserve attention from health professionals [11].

Researchers have found that the prevalence of smoking tobacco use from 1990 to 2019 [12] and alcohol exposure from 1990 to 2017 [13] have shown downward trends all over the world. However, global age-standardized prevalence of obesity increased from 0.7% (0.4–1.2) in 1975 to 5.6% (4.8–6.5) in 2016 in girls, and from 0.9% (0.5–1.3) in 1975 to 7.8% (6.7–9.1) in 2016 in boys [14]. Global age-standardized prevalence of insufficient physical activity in 2016 (36.8%, 35.0–38.0) had increased in high-income countries over time (31.6%, 27.1–37.2, in 2001) [15].

Reinforcing physical exercise is considered to be an important and easily modifiable factor for preventing cancer. Therefore, understanding and planning in regard to the burden of low physical activity related colorectal cancer (LPARCC) is of great public health significance. Then, we searched PubMed and CNKI for studies published between January 1, 1990, and August 4, 2024 on the burden of colorectal cancer deaths and Disability Adjusted Life Years (DALYs), as well as disease trends. Then, we searched PubMed and the China National Knowledge Infrastructure (CNKI) database with the terms ("colorectal cancer") AND ("disease burden") AND ("China") AND ("physical exercise") OR ("physical activity") for previous studies published between 1/1/1990 and 4/8/2024 about the temporal trends of death and disability adjusted life years (DALYs) of LPARCC in China. As a result, previous studies have reported on the disease burden of colorectal cancer and its attributable risk factors [16–18], and have also projected the future changes of trends of colorectal cancer [19, 20] globally and in China. However, there is no available data on the temporal trends of disease burden of LPARCC in Chinese mainland. Therefore, timely monitoring comprehensive temporal trends of LPARCC in China is of great significance for tailoring precise population prevention strategies.

The Global Burden of Diseases Study 2021 (GBD 2021) is a systematic scientific effort, which provides an unique opportunity to analyze the temporal trends of the disease burden attributed to various risk factors [21]. Our study aims to report the recent trends LPARCC deaths and DALYs trends between 1990 and 2021 in China, and also decompose the changes in terms of population growth, population aging, and epidemiological changes.

All data for this study were obtained from the GBD 2021 database, and the details about the GBD 2021 estimation process had been reported previously [22]. In this study, we selected "China" as the location, "colorectal cancer" as the cause, "low physical activity" as the risk factor, and "death" and "DALYs" as the outcome measures. Data was downloaded from the Global Health Data Exchange website (https://ghdx.healthdata.org/gbd-results-tool, accessed date: 4 June 2024). As a secondary analysis of publicly available data, no ethical approval from an institutional review board was required for this study. The data analysis for this study follows the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) [23].

The definition of low physical activity (LPA)

In the GBD 2021, physical activity information on the intensity, duration, and frequency of activities was collected from two standardized questionnaires [the Global Physical Activity Questionnaire (GPAQ) and the International Physical Activity Questionnaire (IPAQ)] [24]. Physical activity was quantified by metabolic equivalents (METs, minutes/week), then was classified into four levels: inactive (< 600 MET-minutes per week), slightly active (600–3,999 MET-minutes per week), moderately active (4,000–7,999 MET-minutes per week), and highly active (≥ 8,000 MET-minutes per week). Finally, LPA was defined as < 3,000 MET-min per week [25, 26].

LPARCC and disease burden metrics

In this study, we focused on the disease burden of colorectal cancer attributable to low physical activity. The indices of disease burden included summary exposure values (SEV), deaths, DALYs, age-standardized mortality rate (ASMR), age-standardized DALYs rate (ASDR), population attributable fraction (PAF). Based on exposure and relative risks, the traditional GBD population attributable fraction (PAF) equation was used to estimate diseases burden.

PAF%=p(RR-1)/[p(RR-1) + 1] ×100%

where p was the proportion of LPA exposed individuals in the total population, and relative risk (RR) referred to the risk effect of LPA on colorectal cancer. In addition, attributable deaths and DALYs were estimated using the total resulting death rate or DALYs, multiplied by the PAF for the risk-outcome pair.

The values and 95% uncertainty interval (UI) of SEV and the number/rate/PAF of LPARCC were also obtained directly from the Global Health Data Exchange website.

Statistical Analysis

Indices such as annual percentage change (ANPC) and average annual percentage change (AAPC) were used to describe the temporal trends of the LPARCC deaths and DALYs :

ANPC = ( e^β − 1 ) × 100%

AAPC = { exp ∑ w_ib_i ∕ ∑ w_i − 1 } × 100%

An age-period-cohort (APC) model was used to analyze the effects of age, period, and cohort on the LPARCC mortality and DALYs. And, this model was based on a log-linear model for the rate, with additive effects from age, calendar period, and birth cohort [27]:

Logλ_ij = µ + α_i + β_j + γ_k i = 1, 2,. . ., I,

j = 1, 2,. . ., J,

k = j − i + I.

where µ α_i β_j and γ_k refer to the intercept term, age effects, period effects, and cohort effects. We present the APC results as follows: (1) net drift, which represents the annual percentage change of the expected age-adjusted rates over time, (2) local drifts, which assess the annual percentage change of the expected age-specific rates over time, and the longitudinal age curve, which shows the fitted longitudinal age-specific rates in the reference cohort, adjusted for period deviations, (3) period RRs, the ratio of age-specific rates in each period relative to the reference period, and (4) cohort RRs, the ratio of age-specific rates in each cohort relative to the reference cohort. The longitudinal age curve, time period RR, and cohort RR represent the age, period, and cohort effect, respectively.

Finally, based on a Poisson distribution, a joinpoint regression analysis was used to assess the temporal trends of age-standardized rates (SEV, ASMR, ASDR, and ASPAF ) [28]:

ln (y) = α + βx + ε

where y is the mortality/DALYs rate, α is the constant term, β is the regression coefficient, and ε is the random error term.

Decomposition analysis

Finally, we adopted a recently developed decomposition method to attribute changes in the total number of LPARCC deaths and DALYs to population growth, population aging, and mortality change [29, 30]. Compared to previous studies [21, 31, 32], this method was insensitive to the decomposition order of the 3 components and the choice of reference group [30], which enhanced the stability of our results:

$$\:{M}_{p}={\sum\:}_{i=1}^{20}{{\left({N}_{2}-{N}_{1}\right)s}_{i1}m}_{i1}$$

$$\:{M}_{a}={\sum\:}_{i=1}^{20}{N}_{1}\left({s}_{i2}-{s}_{i1}\right){m}_{i1}$$

$$\:{M}_{m}={\sum\:}_{i=1}^{20}{{N}_{1}s}_{i1}\left({m}_{i2}-{m}_{i1}\right)$$

$$\:{I}_{pa}={\sum\:}_{i=1}^{20}\left({N}_{2}-{N}_{1}\right)\left({s}_{i2}-{s}_{i1}\right){m}_{i1}$$

$$\:{I}_{pm}={\sum\:}_{i=1}^{20}\left({N}_{2}-{N}_{1}\right){s}_{i1}\left({m}_{i2}-{m}_{i1}\right)$$

$$\:{I}_{am}={\sum\:}_{i=1}^{20}{N}_{1}\left({s}_{i2}-{s}_{i1}\right)\left({m}_{i2}-{m}_{i1}\right)$$

$$\:\:{\:\:\:\:\:\:\:\:I}_{pam}={\sum\:}_{i=1}^{20}{(N2-N}_{1})\left({s}_{i2}-{s}_{i1}\right)\left({m}_{i2}-{m}_{i1}\right)$$

where M_a, M_p, and M_m were the main effects of population ageing, population growth, and mortality change, respectively; I_pa, I_pm, I_am, and I_pam denote the 2-way and 3-way interactions; m_ij and s_ij denote the age-specific mortality rate and proportion of population, for the ith age group in the jth year (i = 1, 2,. . ., 20; j = 1, 2); and N₁ and N₂ represent the population size for group 1 and group 2, respectively. The change in the number of deaths can then be attributed to population ageing, population growth, and change of age-specific mortality rate as follows:

$$\:\:\:\:\:\:\:\:\:\:P={M}_{p}+1/2{I}_{pa}+1/2{I}_{pm}+1/3{I}_{pam}$$

$$\:{\:\:\:\:\:\:\:\:A=M}_{a}+1/2{I}_{pa}+1/2{I}_{am}+1/3{I}_{pam}$$

$$\:\:\:\:\:\:\:\:\:M={M}_{m}+1/2{I}_{pm}+1/2{I}_{am}+1/3{I}_{pam}$$

All statistical analyses were conducted using R 3.6.0.

Changes in the disease burden of LPARCC between 1990 and 2021

As shown in Table 1, all ages and age-standardized rates of low physical activity showed upward trends from 1990 to 2021, with percentage changes of 0.46 (0.16–0.86) and 0.16 (95% CI: -0.08-0.45), respectively. For death, the percentage changes of some indices such as the estimated number (1.91 (0.96–3.27)), all-age PAF (0.27 (-0.06–0.72)), mortality (1.41 (0.62–2.53)), and ASPAF (0.06 (-0.22-0.46)), showed upward trends. But the percentage change of ASMR was − 0.07 (-0.38-0.37) and had a non-significantly decreased trend. For DALYs, although the percentage changes of the estimated number (1.50 (0.71–2.75)) and all ages rates (1.06 (0.41–2.10)) increased significantly from 1990 to 2021, there were no significant changes in other disease burden indices such as all ages PAF, ASPAF and ASDR. More details were shown in Table 1.

Table 1

The SEV and burden of colorectal cancer attributable to low physical activity
Metric	Measure	Year				Percentage Change (UI)
Metric	Measure	1990		2021		Percentage Change (UI)
SEV	All ages (%)	14.37	(11.13–18.16)	21	(16.91–25.91)	0.46	(0.16–0.86)
	Age-standardized (%)	16.69	(13.19–20.47)	19.31	(15.57–23.94)	0.16	(-0.08–0.45)
Colonrectal cancer
Death	Numbers (n, 1/103)	5734.54	(3368.81–8371.03)	16698.47	(10065.03–24625.76)	1.91	(0.96–3.27)
	PAF (all ages, %)	0.05	(0.03–0.07)	0.06	(0.04–0.09)	0.27	(-0.06–0.72)
	Age-standardized PAF (%)	0.06	(0.04–0.09)	0.06	(0.04–0.09)	0.06	(-0.22–0.46)
	Mortality (All ages, 1/105)	0.49	(0.29–0.71)	1.17	(0.71–1.73)	1.41	(0.62–2.53)
	ASMR (1/105)	0.93	(0.55–1.36)	0.87	(0.53–1.29)	-0.07	(-0.38–0.37)
DALYs	Numbers (n, 1/103)	128352.6	(74846.96–188831.95)	320464.35	(192274.95–474069.92)	1.50	(0.71–2.75)
	PAF (all ages, %)	0.04	(0.02–0.05)	0.05	(0.03–0.07)	0.30	(-0.04–0.77)
	Age-standardized PAF (%)	0.04	(0.03–0.06)	0.05	(0.03–0.07)	0.08	(-0.2–0.47)
	All-age rate (1/105)	10.91	(6.36–16.05)	22.52	(13.51–33.32)	1.06	(0.41–2.1)
	ASDR (1/105)	17.12	(10.06–24.93)	15.63	(9.47–22.88)	-0.09	(-0.37–0.33)
*Abbreviations: SEV, summary exposure values; DALYs, disability adjusted life years; PAF, population attributable proportion;
ASMR, age-standardized mortality rate; ASDR, age-standardized DALYs rate; ASPAF, age-standardized population attributable proportion;

Table 2 presented the results of the Joinpoint regression model. For LPARCC, the AAPC between 1990 and 2021 for ASMR, the ASPAF for death rates, ASDR and ASPAF for DALYs were − 0.22 (-0.52-0.90), 0.20 (0.10–0.30), -0.29 (-0.55- -0.03), and 0.25 (0.15–0.34), respectively. In addition, although the changes in trends of LPARCC disease burden varied across five periods, there were significantly upward trends in ASMR (0.88, 95% CI: 0.44–1.36), ASDR (1.20, 95% CI: 0.79–1.61), ASPAF for mortality (1.06, 95% CI: 0.38–1.76), and DALYs (0.65, 95% CI: 0.53–0.78) attributable to low physical activity during 2015 to 2021, respectively.

Table 2

JoinPoint analysis of the trends of disease burden of low physical activity related colorectal cancer in China, 1990 to 2021
	Trend 1		Trend 2		Trend 3		Trend 4		Trend 5		1990–2021
	Period	APC(95% CI) (%)	Period	APC(95% CI) (%)	Period	APC(95% CI) (%)	Period	APC(95% CI) (%)	Period	APC(95% CI) (%)	AAPC(95% CI) (%)
ASMR
	1990–1999	-0.60 (-0.86–0.35)	1999–2004	-0.44 (-0.42–1.30)	2004–2007	-2.01 (-4.61–0.67)	2007–2015	-0.33 (-0.68–0.03)	2015–2021	0.88 (0.40–1.36)	-0.22 (-0.52–0.09)
Age-standardized PAF of death rates
	1990–2002	2.47(2.17–2.78)	2002–2005	-2.43(-2.55 - -2.31)	2005–2008	0.47(0.04–0.90)	2008–2014	-0.74(-1.04 - -0.44)	2014–2021	1.06(0.38–1.76)	0.20 (0.10–0.30)
ASDR
	1990–1994	-1.06 (-1.28 - -0.85)	1999–2004	0.07 (-0.66–0.80)	2004–2007	-2.02 (-4.18–0.17)	2007–2015	-0.09 (-0.39–0.20)	2015–2021	1.20 (0.79–1.61)	-0.29 (-0.55 - -0.03)
Age-standardized PAF of DALYs rates
	1990–2001	-0.02 (-0.07–0.03)	2001–2004	0.55 (-0.16–1.26)	2004–2007	-0.26 (-0.93–0.41)	2007–2015	0.38 (0.29–0.47)	2015–2021	0.65 (0.53–0.78)	0.25 (0.15–0.34)
Abbreviations: 95% CI, 95% confidence interval; AAPC, average annual percent change; APC, annual percent change; ASMR, age-standardized mortality rate; ASDR, age-standardized DALYs rate; PAF, population attributable proportion; DALYs, disability adjusted life years; ASPAF, age-standardized population attributable proportion;

Effects of age, time period, and cohort on the LPARCC burden between 1990 and 2019

Figure 1 demonstrated the age-period-cohort analysis results on the death of LPARCC. For mortality, local and net changes showed a gradual downward trend until around age 40, reaching a minimum at around age 42, followed by an upward trend with a peak occurring at around age 83 and decreased thereafter (Fig. 1A). The longitudinal age curve showed that mortality rates remained relatively stable until around age 60, started to sharply increase thereafter, reached a peak around aged 85 to 90 years, and then showed an decreased trend (Fig. 1B). As shown in Fig. 1C, the period rates exhibited a declining trend until around 2018, followed by an increase trend. Finally, The estimated cohort rates showed a generally flat trend but start to gradually decrease after 1950 (Fig. 1D). As shown in Fig. 2, the similar trends were seen in the trends of LPARCC DALYs.

Trends in Disease Burden from 1999 to 2019

Table 3 presented decomposition analysis results on the disease burden of LPARCC. In 2021, the number of LPARCC death increased by 191.19% compared to 1990, which could be attributed to population aging (170.62%), changes in LPA related mortality (-15.42%), and population growth (35.99%). Furthermore, the number of LPARCC DALYs increased by 149.67%, with age structure, mortality rate changes, and population size accounting for 135.21%, -17.93%, and 32.40%, respectively.

Table 3

The number and contribution changes of low physical activity related colorectal cancer deaths and DALYs from 1990 to 2021
	Number of deaths or DALYs (n, 1/103)		Changes between 1990 and 2021 (%)
	1990	2021	Total change	Change due to mortality change	Change due to demographic	Change due to age structure	Change due to population size
Death	5734.54	16698.47	191.19	-15.42	206.61	170.62	35.99
DALYs	128352.6	320464.35	149.67	-17.93	167.61	135.21	32.4
Abbreviations: DALYs, disability adjusted life years;

This study systematically summarized the burden of LPARCC in China from 1990 to 2021, and found that the number of deaths and DALYs increased by 191.19% and 149.67%, respectively. In addition, the results of decomposition methods supported that the population aging was the main reason for the changes in the LPARCC burden over the past three decades.

Our data showed that the all ages rate of summary exposure value of LPA activity in China increased slightly from 14.37% in 1990 to 21.00% in 2021, which could be explained by the development of social economy and industrial technology. A pooled analysis of 358 population-based surveys with 1.9 million participants had found that the LPA prevalence in 2016 was more than twice as high in high-income countries (36.8%, 35.0–38.0) as in low-income countries (16.2%, 14.2–17.9), and the LPA had increased in high-income countries over time (31.6%, 27.1–37.2, in 2001) [15]. In addition, a case control study among an African population suggested that approximation to a western lifestyle with high calorie diet and low physical activity was the predominant association with colorectal cancer [33]. On the contrary, regular physical exercise was helpful to reduced the incidence risk of cancers not only by promoting weight loss, but also by reducing insulin levels, IGF-1 levels, IGF binding protein-3 levels, and leptin levels in the human body. And, physical exercise could lower the colorectal cancer risk by decreasing the contact time between colon mucosa and gastrointestinal carcinogens [34]. Thus, it is crucial to carry out the science popularization education about the benefit of physical exercise on health and advocate healthy lifestyle to the public.

Our results presented that despite the temporal trends of mortality and DALYs of LPARCC fluctuated in five different time segments, the values of disease burden indices had shown upward trends during 2015 to 2021 year. These findings aligned with previous studies, which reported the increased temporal patterns of disease burden of colorectal cancer in China and globally [17]. In addition, in order to describe the short-term trends of LPARCC accurately, we adapted the Joinpoint analysis method which divided the long-term trend line into several segments and analyzed each time period [28]. The difference of temporal trends in each period could be explained by the following two reason. On the one hand, the development of industry and economy and the shift of lifestyle such as western diet and low physical exercise over time could affect the LAPCC death and DALYs. On the other hand, this might be related with the increasing coverage of the national cancer registry system and population-based screening projects. In 2002, the National Central Cancer Registry was launched under the supervision of the former Ministry of Health, and was responsible for systematically collecting, analyzing, and interpreting cancer data [35]. Consequently, a significantly increased trend of LPARCC DALYs rates occurred in the period from 1999 to 2004. Then, rapid downward trends for ASMR and all ages mortality rate appeared during 2004–2015, which could be explained by that the national rural and urban cancer screening programs has been implemented in high-risk areas of China focusing on screening colorectal cancer since 2005 and 2012, respectively [36]. Notably, in recent years, a significantly increased trend occurred in the LPARCC death or DALYs, which reminded us that primary prevention measures such as enhancing physical exercise should be supplemented to control the burden of LPARCC.

We further analyzed the effects of age, period, and cohort factors on the trends for death and DALYs of LPARCC. Regarding the age effects, the peak of the longitudinal age curve shifted to over 80 years, which were similar to the peak age of mortality and incidence reported by the previous studies [30]. These age-specific trends in both LPARCC death and DALYs might be might be due to both the decrease of age-related biological and metabolic function and the gained weight attributable to low physical activity, as explained by the similar studies of stomach cancer [37]. In addition, regarding periods effect, it was a reflection of the changes in term of social, economic and policy, as well as the impact of major events at specific points in time [38]. In this study, we found that the two important decreased time points were 2002 and 2012, which corresponded to the onset of national cancer registry system and national rural and urban cancer screening programs. Finally, birth cohort effects represented the influence of physical and social exposures that appeared earlier in the life process and would accumulate with time [39]. In our study, the cohort RRs for LPARCC mortality/DALYs presented gradually increased trends for those cohorts born since 1950s.

For the changes in trends in LPARCC disease burden over the past 30 years, a recently developed decomposition method was used to attribute changes into population growth, population aging, and age-specific changes [29, 30]. As a result, population aging contributed to most of the additional LPARCC deaths and DALYs, which could be explained by the continuous increase of the elderly population and the higher incidence in these age groups. Meanwhile, the change due to risk factors is also deserved attention, which would contribute to the increase of disease burden. Therefore, considering the persistent increase in the number of LPARCC death and DALYs over the past three decades, this cancer should be viewed as be one of the main public health concerns in China. And with the aggravating of population aging, it is necessary to increase the promotion of healthy lifestyle such as enhancing physical exercise to the public.

Our study has several limitations. Firstly, as mentioned in earlier GBD study reports [24], the GBD database was mainly estimated based on mathematical models, which might have deviations from actual data. Secondly, the availability and coverage of data source such as cancer registries, vital registration systems, and verbal autopsies varied across countries or regions, which resulted in data heterogeneity [40, 41]. Finally, other lifestyle factors such as high sugar diet, alcohol and smoke consumption and sleep duration were also recognized to be related with the death and DALYs of LPARCC in China, but the interactive effects of LPA and above risk factors on the disease burden were not reported in this study [42]. Despite these limitations, using the up-to-date data and recent decomposition methods, our study firstly provides a comprehensive understanding of the disease burden of LPARCC from 1990 to 2019 years.

In conclusion, the number of LPARCC death and DALYs generally show upward trends from 1990 to 2021, which could be attributable to the rapid population aging seen in China. It is crucial to strengthen the targeted interventions and address modifiable risk factors, such as advocating and enhancing physical exercise.

LPARCC

low physical activity related colorectal cancer

DALYs

disability-adjusted life years

GBD

Global Burden of Disease

APC

age-period-cohort

ASMR

age-standardized mortality rate

ASDR

age-standardized DALYs rate

BMI

body mass index

IPA1

the International Physical Activity Questionnaire

METs

metabolic equivalents

SEV

summary exposure values

PAF

population attributable fraction

relative risk

uncertainty interval

LPA

low physical activity

ANPC

annual percentage change

AAPC

average annual percentage change

ASPAF, age-standardized population attributable proportion

Conflict of interest:

The authors declare no conflict of interest.

Institutional Review Board Statement

As a secondary analysis of publicly available data, no ethical approval from an institutional review board was required for this study.

Informed Consent Statement:

Not applicable.

Funding:

None

Author Contribution

Conceptualization and design, Qian Yang and Yao Hu; Data extraction, Fang Liu and Yao Hu; Formal analysis, Yao Hu and Qian Yang; Writing - original draft, Qian Yang and Yao Hu; Writing - review and editing, Yao Hu and Qian Yang. All authors read and approved the final manuscript.

Acknowledgments:

We appreciate the works by the 2021 Global Burden of Disease study collaborators.

Data availability statement:

The datasets generated for this study can be found in the GBD at http://ghdx.healthdata.org/gbd-results-tool (accessed date: 4 June 2024).

Rongshou Zheng SZ, Hongmei Zeng S, Wang K, Sun R, Chen L, Li W, Wei. Jie He: Cancer incidence and mortality in China, 2016. Journal of the National Cancer Center 2022.
Botteri E, Iodice S, Bagnardi V, Raimondi S, Lowenfels AB, Maisonneuve P. Smoking and colorectal cancer: a meta-analysis. JAMA. 2008;300(23):2765–78.
Hur J, Smith-Warner SA, Rimm EB, Willett WC, Wu K, Cao Y, Giovannucci E. Alcohol intake in early adulthood and risk of colorectal cancer: three large prospective cohort studies of men and women in the United States. Eur J Epidemiol. 2021;36(3):325–33.
Xie F, You Y, Huang J, Guan C, Chen Z, Fang M, Yao F, Han J. Association between physical activity and digestive-system cancer: An updated systematic review and meta-analysis. J sport health Sci. 2021;10(1):4–13.
Je Y, Jeon JY, Giovannucci EL, Meyerhardt JA. Association between physical activity and mortality in colorectal cancer: a meta-analysis of prospective cohort studies. Int J Cancer. 2013;133(8):1905–13.
Dong Y, Zhou J, Zhu Y, Luo L, He T, Hu H, Liu H, Zhang Y, Luo D, Xu S et al. Abdominal obesity and colorectal cancer risk: systematic review and meta-analysis of prospective studies. Biosci Rep 2017, 37(6).
Ma Y, Yang Y, Wang F, Zhang P, Shi C, Zou Y, Qin H. Obesity and risk of colorectal cancer: a systematic review of prospective studies. PLoS ONE. 2013;8(1):e53916.
Liu PH, Wu K, Ng K, Zauber AG, Nguyen LH, Song M, He X, Fuchs CS, Ogino S, Willett WC, et al. Association of Obesity With Risk of Early-Onset Colorectal Cancer Among Women. JAMA Oncol. 2019;5(1):37–44.
Bradbury KE, Murphy N, Key TJ. Diet and colorectal cancer in UK Biobank: a prospective study. Int J Epidemiol. 2020;49(1):246–58.
Shivappa N, Godos J, Hébert JR, Wirth MD, Piuri G, Speciani AF, Grosso G. Dietary Inflammatory Index and Colorectal Cancer Risk-A Meta-Analysis. Nutrients 2017, 9(9).
Fan J, Liu Z, Mao X, Tong X, Zhang T, Suo C, Chen X. Global trends in the incidence and mortality of esophageal cancer from 1990 to 2017. Cancer Med. 2020;9(18):6875–87.
Spatial temporal. demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet (London England). 2021;397(10292):2337–60.
Manthey J, Shield KD, Rylett M, Hasan OSM, Probst C, Rehm J. Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study. Lancet (London England). 2019;393(10190):2493–502.
Worldwide trends in. body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet (London England). 2017;390(10113):2627–42.
Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants. Lancet Global health. 2018;6(10):e1077–86.
Yin J, Bai Z, Zhang J, Zheng Z, Yao H, Ye P, Li J, Gao X, Zhang Z. Burden of colorectal cancer in China, 1990–2017: Findings from the Global Burden of Disease Study 2017. Chin J cancer Res = Chung-kuo yen cheng yen chiu. 2019;31(3):489–98.
Global regional. national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. lancet Gastroenterol Hepatol. 2022;7(7):627–47.
Li Q, Yu M, Lv H, Zhang L, Deng Y, Yu H. Burden of early-onset colorectal cancer along with attributable risk factors from 1990 to 2019: a comparative study between China and other G20 countries. BMC Public Health. 2023;23(1):1463.
Shao B, Zhu M, Shen K, Luo L, Du P, Li J, Xu J, Deng Y, Lin N, Wu J, et al. Disease Burden of Total and Early-Onset Colorectal Cancer in China from 1990 to 2019 and Predictions of Cancer Incidence and Mortality. Clin Epidemiol. 2023;15:151–63.
Hu S, Li Y, Zhu W, Liu J, Wei S. Global, region and national trends and age-period-cohort effects in colorectal cancer burden from 1990 to 2019, with predictions to 2039. Environ Sci Pollut Res Int. 2023;30(35):83245–59.
Global regional. national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London England). 2018;392(10159):1736–88.
Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England). 2020, 396(10258):1204–1222.
Stevens GA, Alkema L, Black RE, Boerma JT, Collins GS, Ezzati M, Grove JT, Hogan DR, Hogan MC, Horton R, et al. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. Lancet (London England). 2016;388(10062):e19–23.
Global. burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England) 2020, 396(10258):1223–1249.
Kyu HH, Bachman VF, Alexander LT, Mumford JE, Afshin A, Estep K, Veerman JL, Delwiche K, Iannarone ML, Moyer ML, et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ (Clinical Res ed). 2016;354:i3857.
Yin X, Zhang T, Zhang Y, Man J, Yang X, Lu M. The global, regional, and national disease burden of breast cancer attributable to low physical activity from 1990 to 2019: an analysis of the Global Burden of Disease Study 2019. Int J Behav Nutr Phys Act. 2022;19(1):42.
Tzeng IS, Chen JH. Exploring Hepatocellular Carcinoma Mortality Using Weighted Regression Estimation for the Cohort Effect in Taiwan from 1976 to 2015. Int J Environ Res Public Health 2022, 19(9).
Joinpoint Regression Program. version 4.9.1.0 Surveillance Research. [http://surveillance.cancer.gov/joinpoint/]
Cheng X, Yang Y, Schwebel DC, Liu Z, Li L, Cheng P, Ning P, Hu G. Population ageing and mortality during 1990–2017: A global decomposition analysis. PLoS Med. 2020;17(6):e1003138.
Cheng X, Tan L, Gao Y, Yang Y, Schwebel DC, Hu G. A new method to attribute differences in total deaths between groups to population size, age structure and age-specific mortality rate. PLoS ONE. 2019;14(5):e0216613.
Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, Brenner H, Dicker DJ, Chimed-Orchir O, Dandona R, Dandona L, et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol. 2017;3(4):524–48.
Global regional. national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet (London England). 2016;388(10053):1459–544.
Katsidzira L, Gangaidzo IT, Makunike-Mutasa R, Manyanga T, Matsena-Zingoni Z, Thomson S, Matenga JA, Rusakaniko S, Ramesar R. A case-control study of risk factors for colorectal cancer in an African population. Eur J cancer prevention: official J Eur Cancer Prev Organisation (ECP). 2019;28(3):145–50.
Bardou M, Barkun AN, Martel M. Obesity and colorectal cancer. Gut. 2013;62(6):933–47.
Maomao C, He L, Dianqin S, Siyi H, Xinxin Y, Fan Y, Shaoli Z, Changfa X, Lin L, Ji P, et al. Current cancer burden in China: epidemiology, etiology, and prevention. Cancer biology Med. 2022;19(8):1121–38.
Cao M, Li H, Sun D, He S, Yu Y, Li J, Chen H, Shi J, Ren J, Li N, et al. Cancer screening in China: The current status, challenges, and suggestions. Cancer Lett. 2021;506:120–7.
Fan Y, Jiang Y, Li X, Li X, Li Y, Wu H, Pan H, Wang Y, Meng Z, Zhou Q et al. Burden of Lung Cancer Attributable to Occupational Carcinogens from 1990 to 2019 and Projections until 2044 in China. Cancers 2022, 14(16).
Okui T. An age-period-cohort analysis for prevalence of common psychiatric disorders in Japan, 1999–2017. Soc Psychiatry Psychiatr Epidemiol. 2021;56(4):639–48.
Janssen F, Kunst AE. Cohort patterns in mortality trends among the elderly in seven European countries, 1950-99. Int J Epidemiol. 2005;34(5):1149–59.
The global. regional, and national burden of colorectal cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. lancet Gastroenterol Hepatol. 2019;4(12):913–33.
Fitzmaurice C, Abate D, Abbasi N, Abbastabar H, Abd-Allah F, Abdel-Rahman O, Abdelalim A, Abdoli A, Abdollahpour I, Abdulle ASM, et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol. 2019;5(12):1749–68.
Liang YY, Feng H, Chen Y, Jin X, Xue H, Zhou M, Ma H, Ai S, Wing YK, Geng Q, et al. Joint association of physical activity and sleep duration with risk of all-cause and cause-specific mortality: a population-based cohort study using accelerometry. Eur J Prev Cardiol. 2023;30(9):832–43.

No competing interests reported.

Download PDF

Editorial decision: Revision requested
08 Aug, 2024
Editor assigned by journal
08 Aug, 2024
Submission checks completed at journal
06 Aug, 2024
First submitted to journal
05 Aug, 2024

You are reading this latest preprint version

Secular trend of colorectal cancer attributable to low physical activity from 1990 to 2021 in China

Status:

Version 1

Abstract

Objective

Methods

Results

Conclusion

Figures

Background

Methods

The definition of low physical activity (LPA)

LPARCC and disease burden metrics

Statistical Analysis

Decomposition analysis

Results

Changes in the disease burden of LPARCC between 1990 and 2021

Effects of age, time period, and cohort on the LPARCC burden between 1990 and 2019

Trends in Disease Burden from 1999 to 2019

Discussion

Abbreviations

Declarations

Conflict of interest:

Institutional Review Board Statement

Funding:

Author Contribution

Acknowledgments:

Data availability statement:

References

Additional Declarations

Status:

Version 1