Burden of Colorectal Cancer Attributable to Low Dietary Calcium Intake in China from 1990 to 2023 and Projections to 2040: A Systematic Analysis and Comparison with Global Levels

Low dietary calcium intake (DCI) is a modifiable risk factor for colorectal cancer (CRC). This study examined CRC burden attributable to low DCI in China and globally from 1990 to 2023 using Global Burden of Disease 2023 data. Joinpoint regression assessed temporal trends, age-period-cohort analysis characterized age, period, and cohort patterns, and Bayesian age-period-cohort modeling projected burden through 2040. In 2023, China had 15,934 attributable deaths (95% uncertainty interval [UI]: 10,999-22,042) and 371,105 disability-adjusted life years (DALYs; 95% UI: 253,587-509,717), representing decreases of 14.67% and 31.77% since 1990, respectively, whereas global counts increased. China's age-standardized mortality and DALY rates declined by 70.00% and 72.19%, with average annual percentage changes of -3.60% and -3.82%, respectively. Both rates increased during 2020-2023. Women had a higher attributable burden than men, and mortality rates were relatively high in older age groups. Period and cohort rate ratios declined in China. By 2040, attributable deaths and DALYs in China were projected to reach 44,191 and 837,178, respectively, with larger relative increases than globally. Despite long-term declines, the recent rebound and projected increases highlight the continuing relevance of improving dietary calcium adequacy and CRC prevention in China, with attention to age- and sex-specific differences in attributable burden.