S311 Increasing State-Level Burden of Early Onset Colorectal Cancer in the United States: A Systematic Analysis From Global Burden of Disease 1980-2021

Introduction: Early-onset colorectal cancer (EOCC, diagnosed <50 years) incidence is rising in the US. Understanding burden distribution across specific younger age groups, states, and metrics (incidence, mortality, disability-adjusted life years [DALYs]) is crucial for targeted interventions. We analyzed trends and state-level disparities in U.S. colorectal cancer burden across these younger age groups. Methods: We utilized state and national colorectal cancer incidence (1990-2021), mortality (1980-2021), and DALY (1990-2021) rate estimates (per 100,000) from the Global Burden of Disease (GBD) 2021 study. Data were analyzed for 7 fine age strata (<20, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49 years). Trends were assessed visually; state variations were compared using 2021 rates. Results: National average incidence rates increased consistently since 1990 from age 25-29 through 45-49 years. Conversely, national mortality and DALY rates initially declined but showed sustained increases post-early/mid-2000s, primarily affecting the 30–49-year age range. Significant state-level disparities existed across all metrics, widening with age and most pronounced in the 45-49 stratum in 2021. Higher burdens frequently clustered in Southern and Appalachian states, particularly from age 30 upwards. Conclusion: Colorectal cancer burden is increasing across distinct young adult age groups (incidence from 25+, mortality/DALYs recently from 30+). Profound, geographically patterned state-level disparities exist. Findings underscore the need for age-specific research, heightened clinical suspicion extending into younger adulthood (especially 30+), and targeted public health strategies in high-burden states.