S353 Disparities in Colorectal Cancer Burden and Risk by State and Sex in the United States: A Comprehensive Analysis of GBD 2021 Data

Introduction: Colorectal cancer (CRC) remains a significant public health concern in the United States, with notable geographic variation in its incidence, mortality, and associated risk factors. This study provides a comprehensive state-level assessment of CRC burden and risk profiles utilizing data from the Global Burden of Disease (GBD) 2021 study. Methods: We extracted age-standardized CRC incidence, prevalence, mortality, and disability-adjusted life year (DALY) rates for all 50 states from the GBD 2021 database. The top and bottom 3 states were identified for each metric. DALYs were stratified by sex to assess gender disparities. We also analyzed the contribution of major behavioral, metabolic, and dietary risk factors to CRC DALYs at the state level. Results: Kentucky and Louisiana consistently ranked among the top 3 for CRC incidence, prevalence, and DALY burden. Mississippi had the highest CRC mortality (18.36 per 100,000) and DALY rate (473.82 per 100,000), while California, Utah, and Washington D.C. had the lowest incidence and prevalence. Males had higher CRC prevalence and DALY rates than females in all states. The highest male prevalence was in Kentucky (348.63 per 100,000); the lowest was in D.C. (221.24 per 100,000). Risk factor analysis showed diet low in whole grains contributed most to national CRC DALYs (56.53 per 100,000). Males had higher DALY rates across most risk factors, but low physical activity and diets low in milk and calcium were more strongly associated with female CRC burden. The greatest gender disparities were linked to alcohol use. Conclusion: This state-level analysis based on GBD 2021 data reveals substantial geographic and gender-based disparities in the burden of colorectal cancer across the United States. Southern states exhibit a disproportionately high CRC burden, largely attributable to modifiable metabolic and dietary risk factors. These findings underscore the critical need for state-specific, gender-sensitive preventive strategies, including expanded access to screening and regionally tailored interventions targeting high-risk dietary and lifestyle behaviors.