S356 Behavioral Drivers of Colorectal Cancer in High-Income Countries: A 30-Year Epidemiological Analysis

Introduction: Despite advanced health systems, high-income countries (HICs) continue to face a significant and growing burden of colorectal cancer (CRC) linked to modifiable behavioral risk factors. Unhealthy diets, physical inactivity, alcohol consumption, and tobacco use have emerged as key contributors to CRC-related mortality and disability in these regions. Methods: Using the Global Burden of Disease Study 2021 comparative risk assessment (CRA) framework, we estimated the CRC burden attributable to behavioral risk factors (BRF) across World Bank HICs. Population-attributable fractions (PAFs) were calculated by comparing the distribution of each risk exposure—dietary risk factors (DRF), high alcohol use, low physical activity (LPA), and tobacco use—to theoretical minimum risk exposure levels (TMRELs). These PAFs were applied to CRC deaths, disability-adjusted life years (DALYs), and years lived with disability (YLDs) to derive the proportion attributable to behavioral risks. Trends from 1990 to 2021 were assessed using annualized percentage change (APC) in age-standardized rates and absolute counts stratified by age, sex, year and location. Results: Between 1990 and 2021, CRC deaths attributable to DRF increased from 103,318 (95% UI: 25,119–159,948) to 137,253 (32,702–214,824); due to LPA from 20,527 (13,013–29,079) to 28,547 (17,379–39,314); high alcohol use from 19,750 (14,747–24,815) to 24,435 (18,842–30,108); while tobacco-related deaths declined from 14,082 (8,799–19,376) to 13,206 (7,924–18,684). Western Europe and North America bore the highest burden, but Asia Pacific showed the fastest rise, with APCs of 2.54% (deaths) and 3.02% (YLDs). Age-wise, individuals aged ≥55 experienced increased burden (APC in deaths: +0.34%; DALYs: +0.82%), while those aged 20–54 saw a slight decline in deaths (–0.05%) but a rise in DALYs (+0.5%). Men consistently showed higher burden than women, with APCs for deaths (1.08% vs 0.64%), DALYs (0.75% vs 0.27%), and YLDs (2.16% vs 1.52%). Conclusion: In 2021, deaths due to BRF accounted for 50.37% of all CRC related deaths in HICs. From 1990 to 2021, the burden of CRC due to BRF rose significantly, driven by DRF, LPA, and alcohol use—especially among men and those aged 55 and above. While tobacco-related deaths declined, rising trends in Asia Pacific and persistent sex disparities underscore the need for targeted, lifestyle-focused interventions.