Mohamed A. B. Elnaggar, MD1, Mohammed Y. Youssef, MD2, Ismail Elkhattib, MBBCh3 1Hartford Healthcare, Hartford, CT; 2Hunt Regional Medical Center, Greenville, TX; 3University of Nebraska, Hartford, CT Introduction: Physical inactivity is a modifiable risk factor implicated in colorectal cancer development and outcomes. Understanding its contribution to disease burden over time can inform prevention strategies. To evaluate long-term trends in mortality, disability-adjusted life years (DALYs), and proportional burden attributable to low physical activity in colorectal cancer, stratified by sex, in the United States from 1990 to 2021. Methods: We extracted data from the Global Burden of Disease (GBD) 2021 database for colorectal cancer attributable to low physical activity in the U.S. Age-standardized mortality rates (ASMR), DALY rates per 100,000, percentage contributions to total DALYs and deaths, and death counts were assessed by sex in 1990 and 2021. Estimates are presented with 95% uncertainty intervals (UIs). Results:
Age-Standardized Death Rate declined across all groups:
Males: from 1.06 (95% UI: 0.50–1.87) in 1990 to 0.82 (0.48–1.17) in 2021
Females: from 1.41 (0.79–2.06) to 0.94 (0.54–1.36)
Both sexes: from 1.27 (0.73–1.92) to 0.82 (0.48–1.17)
DALY Rate per 100,000 also declined:
Males: from 18.44 (9.10–31.69) to 15.26 (8.90–21.79)
Females: from 25.74 (14.50–37.71) to 18.12 (10.75–26.35)
Both sexes: from 22.63 (13.04–32.99) to 15.26 (8.90–21.79)
Proportional DALY percent (% of all colorectal cancer DALYs):
Males: 3.2% in 1990 → ~3.4% in 2021
Females: 6.6% → 7.0%
Both sexes: 4.8% → 4.8%
Proportional Mortality (% of colorectal cancer deaths):
Males: 4.2% → 4.4%
Females: 8.1% → 8.7%
Both sexes: 6.2% → 6.4%
Death Counts Attributable to Low Physical Activity:
Increased from 4,342 (95% UI: 2,476–6,546) in 1990 to 5,135 (3,039–7,306) in 2021 for both sexes combined
Discussion: From 1990 to 2021, while age-standardized death and DALY rates for colorectal cancer attributable to low physical activity declined, the absolute number of deaths rose, and proportional burden remained high, particularly in females. These findings highlight a persistent and growing impact of physical inactivity on colorectal cancer outcomes, underscoring the need for targeted physical activity promotion and policy interventions.
Figure: Trends of DALYs rate per 100k, Death rate per 100k , DALYs percent, Death numbers and death percent stratified by sex (Males in purple, Females in Orange and Age adjusted in green)
Disclosures: Mohamed A. Elnaggar indicated no relevant financial relationships. Mohammed Y. Youssef indicated no relevant financial relationships. Ismail Elkhattib indicated no relevant financial relationships.
Mohamed A. B. Elnaggar, MD1, Mohammed Y. Youssef, MD2, Ismail Elkhattib, MBBCh3. P0510 - Trends in the Burden of Low Physical Activity-Related Colorectal Cancer in the United States: A GBD 1990-2021 Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
