Colorectal cancer in Saudi Arabia, 1990-2023: An epidemiological ecological study and forecasting projections to 2030

Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide. In the Kingdom of Saudi Arabia (KSA), CRC incidence has risen substantially over recent decades. This study aimed to assess the burden and temporal trends of CRC in KSA from 1990 to 2023 and to forecast its future burden through 2030.

We analyzed data from the Global Burden of Disease (GBD) Study 2023 from 1990 to 2023. Age-standardized rates and case counts were extracted for prevalence, incidence, deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). We conducted decomposition analysis, age-period-cohort analysis, joinpoint regression, and forecasting through 2030 using autoregressive integrated moving average (ARIMA), error-trend-seasonal (ETS) exponential smoothing, and Poisson regression models.

Between 1990 and 2023, age-standardized CRC prevalence rates per 100,000 population increased from 30.5 to 81.7 for prevalence (168% increase; APC: 3.91%), from 9.7 to 21.2 for incidence (118% increase; APC: 3.33%), and from 8.8 to 13.5 for mortality (53% increase; APC: 2.18%). Absolute case counts rose more steeply: prevalence increased from 2001 to 14,136 cases (606.5%), incidence from 532 to 2961 cases (456.8%), deaths from 414 to 1526 cases (268.1%), and DALYs from 12,737 to 45,774 (259.4%). Females experienced greater relative increases than males across most measures with narrowing the historical male predominance (male-to-female incidence ratio declined from 1.39 to 1.05). Decomposition analysis revealed population growth as the primary driver of increased burden (contributing 30.2-96.0% of the increase), while changes in age-specific mortality rates offset the expected rise in deaths and DALYs by approximately 50%. Joinpoint analysis showed consistent linear increases with significant trend points changes. Forecasts to 2030 project modest declines for both sexes combined (incidence: -15.9% to 17.9 per 100,000; DALYs: -6.7% to 252.5 per 100,000), with marked sex differences: females are expected to experience substantial reductions (incidence: -33.6%; prevalence: -22.6%; DALYs: -16.5%), while males show lower changes or slight increases (incidence:-6.2%; prevalence:2.9% DALYs: -1.4%).

CRC burden in KSA increased substantially from 1990 to 2023, driven primarily by population growth and aging, with a partial offset by improvements in mortality rates. The narrowing sex gap reflects rising rates among females. While modest declines are projected toward 2030, CRC will remain a major public health challenge. Strengthened primary prevention efforts targeting modifiable risk factors and enhanced screening coverage are urgently needed.