Abstract
Background: Over recent decades, colorectal cancer (CRC) burden measures have changed worldwide, influenced partly by variations in the Human Development Index (HDI). The purpose of current study was to evaluate the effect of HDI on CRC incidence, mortality, and the mortality-to-incidence ratio (MIR) from 1990 to 2023, and to explore the HDI inequality in these measures over time. Methods: Age-standardized CRC incidence and mortality rates from the Global Burden of Disease study were analyzed alongside HDI data from the UN. The impact of HDI on CRC indicators from 1990 to 2023 was assessed using Generalized Estimating Equations (GEE). HDI inequality in CRC indicators for 1990 and 2023 was measured with the Concentration Index (CI), and the contribution of HDI to temporal inequalities was evaluated via Blinder-Oaxaca decomposition analysis. Results: Globally, CRC incidence and mortality inequality decreased while MIR inequality increased from 1990 to 2023, with these trends varying according to HDI levels. Higher HDI related with increased CRC incidence and mortality, except among very high HDI countries (HDI >0.80) where both decline. The impact of HDI on CRC incidence and mortality decreased over time, especially in higher HDI countries (HDI>0.70). The distribution of HDI play role in the reduction of the MIR, especially among low (HDI<0.55) and very high HDI countries (HDI>0.80). Conclusion: Our study has found evidence of the role of HDI distribution and its impact on temporal variation of CRC burden measures from 1990 to 2023.