Demographic and Regional Trends of Colorectal Cancer-Related Mortality in Young Adults in the United States, 
1999–2020: A Cohort Study

Introduction Data on mortality trends for colorectal cancer (CRC) in young adults is sparse. So, this study aims to evaluate trends in CRC-related death rates in young adults. Methods Data on mortality from the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research database were examined in this retrospective cohort analysis. We focused on young adults aged 25 to 45 who died with colorectal cancer (CRC) listed as an underlying cause from January 1999 to December 2020. The study was conducted in August 2023. Individuals aged 25 to 45 years with colorectal cancer (CRC) are noted as a factor in or the root cause of death. The study measured age-adjusted mortality rates (AAMR) for colorectal cancer (CRC) per 100,000 people in the United States, categorized by sex, ethnicity, race, and geographical location. Results From 1999 to 2020, there were 37,601 deaths related to colorectal cancer (CRC) among young adults. Of these, 20,621 (54.8%) were men, and 16,980 (45.2%) were women. The deaths included 7,039 (18.7%) Black individuals, 4,667 (12.4%) Hispanic individuals, and 23,684 (63.0%) White individuals. The overall age-adjusted mortality rates (AAMR) for colorectal cancer (CRC) among young adults rose from 2.0 in 1999 to 2.4 in 2020. Both adult women and men had an increase in mortality, with males consistently exhibiting higher age-adjusted mortality rates (AAMRs). All ethnic and racial groups saw an increase in age-adjusted mortality rates (AAMR), with Black individuals having the highest rates (3.2 in 1999 to 3.3 in 2020). During the same period, the age-adjusted mortality rates (AAMRs) of White and Hispanic people increased from 1.8 to 2.4 and 1.5 to 2, respectively. age-adjusted mortality rates (AAMRs) were either steady or dropping for most demographic and regional categories between 1999 and 2012; however, between 2012 and 2020, there was an uptick. States like Mississippi, Arkansas, Alabama, Oklahoma, and West Virginia were in the upper 90th percentile rank for colorectal cancer (CRC)-caused mortality, reflecting a higher burden in comparison to states in the lowest 10th percentile rank. Conclusion Young adults in the United States had higher rates of colorectal cancer (CRC) death between 1999 and 2020; these rates first stabilized before rising in the latter years. Black individuals faced a 1.38 to 1.65-fold higher age-adjusted mortality rates (AAMR) compared to Hispanic and White individuals, respectively. Targeted health policies are essential to address the rising burden of colorectal cancer (CRC) in young adults, emphasizing prevention, early detection, treatment, and reducing disparities.