Global economic impact of modifiable risk factors in colorectal cancer: A comprehensive analysis using GBD 2023 across 189 countries.

Abstract

e15740 Background: Colorectal cancer (CRC) generates major healthcare expenditures worldwide. Leveraging Global Burden of Disease 2023 (GBD 2023) data, we assessed the economic impact of modifiable risk factors for CRC across 189 countries. Methods: Using the GBD 2023 comparative risk assessment framework, we quantified CRC burden attributable to high body-mass index (BMI), tobacco use, alcohol consumption, physical inactivity, and low fruit/vegetable intake. Disability-adjusted life years (DALYs) were estimated based on standard life expectancy tables. Economic burden was calculated per WHO-recommended cost-of-illness methodology, integrating country-specific cost data from national health accounts and published analyses. Incidence and mortality were stratified by World Bank income classifications. Results: In 2023, there were 1,970,000 incident CRC cases and 915,000 CRC deaths globally, resulting in 21,400,000 DALYs. Modifiable risk factors contributed 32.8% (95% UI: 28.4%–37.2%) of total CRC burden, with high BMI accounting for 18.6% of DALYs, physical inactivity 8.4%, tobacco 3.8%, and low fruit/vegetable intake 2.1%. Direct medical costs attributable to these risk factors surpassed $142 billion USD annually, of which low- and middle-income countries incurred 58% despite representing only 42% of global cases. Indirect costs due to lost productivity totaled $89 billion USD. Countries in the highest quartile for risk factor exposure had 2.3 times higher per-capita CRC healthcare spending than those in the lowest quartile. Conclusions: Modifiable risk factors account for over $231 billion USD in annual economic losses from CRC, disproportionately affecting resource-limited settings. Interventions targeting high BMI and physical inactivity could reduce direct costs by 18–22% and prevent approximately 6.8 million DALYs each year.