Basic Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2024; 16(1): 182-196
Published online Jan 15, 2024. doi: 10.4251/wjgo.v16.i1.182
Colorectal cancer’s burden attributable to a diet high in processed meat in the Belt and Road Initiative countries
Gu Liu, Chang-Min Li, Fei Xie, Qi-Lai Li, Liang-Yan Liao, Wen-Jun Jiang, Xiao-Pan Li, Guan-Ming Lu
Gu Liu, Chang-Min Li, Guan-Ming Lu, Department of Gastrointestinal Surgery, The First Affiliated Hospital, Jinan University, Guangzhou 510630, Guangdong Province, China
Gu Liu, Fei Xie, Qi-Lai Li, Department of Gastrointestinal Surgery, Chenzhou Third People’s Hospital, Chenzhou 423000, Hunan Province, China
Chang-Min Li, Department of Gastrointestinal Surgery, Chenzhou First People’s Hospital and the First Affiliated Hospital of Xiangnan University, Chenzhou, 423000 Hunan Province, China
Liang-Yan Liao, Wen-Jun Jiang, Guan-Ming Lu, Department of Breast and Thyroid Surgery, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
Xiao-Pan Li, Department of Health Management Center, Zhongshan Hospital, Shanghai Medical College of Fudan University, Shanghai 200032, China
Co-first authors: Gu Liu and Chang-Min Li.
Co-corresponding authors: Xiao-Pan Li and Guan-Ming Lu.
Author contributions: Li XP and Lu GM conceived and designed the study; Liu G and Li XP collected and assessed the data; Lu CM, Xie F, Li QL, Liao LY, Jiang WJ and Li XP analyzed the data; Lu GM, Liu G and Li CM provided advice and consultation; Liu G, Li XP and Lu CM wrote the manuscript; Liu G and Li XP worked together to finalize the submission; Lu GM provided the fund support; Liu G and Li CM have contributed equally to this work being the co-first authors, Lu GM and Li XP are the co-corresponding authors; all authors contributed to the article and approved the submitted version.
Supported by National Natural Science Foundation of China, No. 82260532, and No. 32060208.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Xiao-Pan Li, PhD, Adjunct Associate Professor, Department of Health Management Center, Zhongshan Hospital, Shanghai Medical College of Fudan University, No. 180 Fenlin Road, Shanghai 200032, China.
Received: October 1, 2023
Peer-review started: October 1, 2023
First decision: October 18, 2023
Revised: October 20, 2023
Accepted: December 11, 2023
Article in press: December 11, 2023
Published online: January 15, 2024
Research background

Currently, the research on the burden of colorectal cancer (CRC) mainly focuses on the trend analysis of incidence and mortality rates, with only a few in-depth studies on the disability-adjusted life years (DALYs) caused by risk factors, especially in the context of global aging and the lack of cooperation to achieve a community of shared future.

Research motivation

It is crucial to clarify the contribution of risk factors to the burden of CRC in developing countries with rapid aging rates toward enhancing regional cooperation, strengthening control of risk factors, and developing effective intervention measures for cancer screenings.

Research objectives

In this study, we employed DALYs in the Global Buden of Disease 2019 (GBD 2019) study to analyze the magnitude and variations of diet high in processed meat-induced CRC (DHPM-CRC) burden in different gender and age groups, as well as to explore the relevant evidence-based policies and interventions in the Belt and Road Initiative (“B and R”) countries so as to provide a reference for precision-coordinated prevention and control of CRC.

Research methods

The absolute numbers and age-standardized mortality rates (ASMR) and age-standardized DALYs (ASDALR) for DHPM-CRC were calculated. For the estimated metrics, the 95% uncertainty interval was reported, which was calculated by extracting each number 1000 times from the posterior distributions by using the 2.5th and 97.5th order of the uncertainty distribution. ASMR and ASDALR were estimated using a global age structure in 2019 and divided by age into 5 groups: < 15 years, 15-49 years, 50-74 years, and ≥ 75 years. The regional data were stratified by social development index (SDI) (as high-, high-middle, middle-, low-middle, and low-), which is a composite indicator of a country’s lag-distributed income per capita, educational attainment, and the total fertility rate in women aged < 25 years. The methods of SDI development and computation are detailed elsewhere. The trends of DHPM-CRC’s burden from 1990 to 2019 were assessed by the join point regression software (version March 2021) by using the 95% confidence intervals for the identified trend segment. In addition, we evaluated the average annual percent change (AAPC) of ASDALR for DHPM-CRC in gender and age. Meanwhile, we compared the changes in AAPC of burden in DHPM-CRC from 1990 to 2019 or from 2010 to 2019. The relationship between AAPC and increasing/decreasing trend or stability and the map visualization are detailed elsewhere. P < 0.05 was considered to indicate statistical significance.

Research results

The results indicated that: (1) The burden of DHPM-CRC in “B and R” countries in 2019 was positively correlated with the population size; (2) the “B and R” member countries in Central Europe not only exhibit high DALYs of DHPM-CRC but also a large increase in these rates; (3) there are gender differences in the ASR mortality and DALYs of DHPM-CRC in “B and R” countries; (4) there are age differences in the ASDALR of DHPM-CRC in countries along the “B and R” countries; and (5) differences were detected in the trend of DHPM-CRC burden between the Maritime Silk Route and the Land Silk Route along the “B and R” countries.

Research conclusions

Unlike the general global studies, a quantitative and in-depth analysis focusing on the burden of DHPM-CRC helped clarify the impact of a single factor on the burden of CRC, and international organizations with strong links based on this factor are excellent samples for exploring the reduction of disease burden. We noted socioeconomic level, gender, and age differences in the burden of DHPM-CRC in “B and R” countries, thus making targeted cooperation in CRC prevention and control among “B and R” countries possible, especially considering the different development trends of disease burden among countries within the same organization to provide fresh perspectives on CRC prevention and control research.

Research perspectives

In this study, we employed DALYs in the GBD 2019 to analyze the magnitude and variations of DHPM-CRC burden in the gender and age groups and explore the relevant evidence-based policies and interventions in the “B and R” countries so as to provide a reference for precision coordinated prevention and control of CRC.