Keywords
Mortality
Trends
Surveillance
Epidemiology
How to Cite
Abstract
Background: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality in the United States despite advances in screening and treatment. Prior national studies have documented long-term declines in CRC mortality; however, emerging demographic and disparities warrant updated evaluation.
Methods: We conducted a retrospective, population-based analysis of CRC mortality in the United States from 1999 to 2023 using the CDC WONDER database. Adults aged ≥25 years with CRC were identified using ICD-10 codes C18–C20. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Trends were assessed using Joinpoint regression.
Results: From 1999 to 2023, a total of 1,551,550 CRC deaths were recorded among U.S. adults aged ≥25. The overall AAMR declined from 38.23 per 100,000 in 1999 to 22.93 in 2023 (AAPC: –2.14; 95% CI: –2.39 to –1.88; p < 0.001). Overall, the AAMR declined in both sexes between 1999 and 2023; 31.98 to 19.09 (AAPC: -2.16; p < 0.01) among women, as compared to 47.46 to 27.43 (AAPC: -2.31; p < 0.01) among men. Racial disparities persisted, with non-Hispanic Black individuals showing the highest overall AAMR (37.34). Regionally, the Midwest has the highest overall AAMR (30.05). Urban–rural comparisons (1999–2020) showed higher AAMRs in rural areas (32.08) than in metropolitan areas (27.81). Older adults (≥65 years) accounted for most deaths. The most common place of death was home (40.7%).
Conclusions: CRC mortality in the U.S. has declined substantially over the past 25 years; however, significant disparities persist by race, geography, and age.
References
1. De Palma FDE, D'Argenio V, Pol J, Kroemer G, Maiuri MC, Salvatore F. The Molecular Hallmarks of the Serrated Pathway in Colorectal Cancer. Cancers (Basel). 2019: [PMID: 31330830, https://doi.org/10.3390/cancers11071017]
2. Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol. 2019: 89 [PMID: 31616522, https://doi.org/10.5114/pg.2018.81072]
3. Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023: 233 [PMID: 36856579, https://doi.org/10.3322/caac.21772]
4. Siegel RL, Fedewa SA, Anderson WF, Miller KD, Ma J, Rosenberg PS, Jemal A. Colorectal Cancer Incidence Patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017: [PMID: 28376186, https://doi.org/10.1093/jnci/djw322]
5. Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, Jemal A, Schymura MJ, Lansdorp-Vogelaar I, Seeff LC, van Ballegooijen M, Goede SL, Ries LA. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010: 544 [PMID: 19998273, https://doi.org/10.1002/cncr.24760]
6. Schafer EJ, Sung H, Star J, Bandi P, Smith RA, Siegel RL. Colorectal Cancer Incidence in US Adults After Recommendations for Earlier Screening. JAMA. 2025: 824 [PMID: 40758342, https://doi.org/10.1001/jama.2025.9147]
7. Force USPST, Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Krist AH, Kubik M, Li L, Ogedegbe G, Owens DK, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021: 1965 [PMID: 34003218, https://doi.org/10.1001/jama.2021.6238]
8. Weiser MR. AJCC 8th Edition: Colorectal Cancer. Ann Surg Oncol. 2018: 1454 [PMID: 29616422, https://doi.org/10.1245/s10434-018-6462-1]
9. Institute NC. Surveillance, Epidemiology, and End Results (SEER) Program. Available from: https://seer.cancer.gov/.
10. Doubeni CA, Corley DA, Quinn VP, Jensen CD, Zauber AG, Goodman M, Johnson JR, Mehta SJ, Becerra TA, Zhao WK, Schottinger J, Doria-Rose VP, Levin TR, Weiss NS, Fletcher RH. Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study. Gut. 2018: 291 [PMID: 27733426, https://doi.org/10.1136/gutjnl-2016-312712]
11. DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin. 2019: 211 [PMID: 30762872, https://doi.org/10.3322/caac.21555]
12. Hemida MF, Ibrahim AA, Zeeshan N, Faisal MR, Patel K, Hussein M, Dessouky AK, Saghir M, Saghir E, Sarfraz MR, Shahriar Z, Kadour MAH, Elbanna AF, Rahma Dawelbait MA, Ali MF, Abdelkhalek AM, Sayed R, Ali K. Trends and disparities in aortic dissection mortality in the united states: a retrospective analysis. BMC Cardiovasc Disord. 2026: 66 [PMID: 41572202, https://doi.org/10.1186/s12872-025-05446-5]
13. Cheema AAA, Salman A, Raja F, Naqvi HA, Kumari K, Mahmood F, Marrium A, Khan Jadoon MS, Devi S, Bashir E, Ahmed I, Afridi A. Place of death among adults with interstitial lung disease in the United States, 1999-2023: a national population-based study. Ann Med Surg (Lond). 2026: 587 [PMID: 41497035, https://doi.org/10.1097/MS9.0000000000004471]
14. Hemida MF, Ibrahim AA, Goel A, Hussein M, Patel K, Sarfraz MR, Alkasabrah OY, Saghir M, Karmani K, Saghir E, Shahriar Z, Fawzi S, Bahnasy A, Ali MF, Ali A, Abdelkhalek AM, Ahmed R. Twenty-Five Years of Angina–Related Mortality in Elderly Adults Aged ≥ 65 Years: A Retrospective Cohort Study Using Real-World Data from the USA. ASIDE Internal Medicine. 2025: 33 https://doi.org/10.71079/aside.Im.110925248]
15. Society AC. Colorectal Cancer Facts & Figures 2023-2025 2023. Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2023.pdf.
16. Zauber AG. The impact of screening on colorectal cancer mortality and incidence: has it really made a difference? Dig Dis Sci. 2015: 681 [PMID: 25740556, https://doi.org/10.1007/s10620-015-3600-5]
17. Zeineddine FA, Zeineddine MA, Yousef A, Gu Y, Chowdhury S, Dasari A, Huey RW, Johnson B, Kee B, Lee MS, Morelli MP, Morris VK, Overman MJ, Parseghian C, Raghav K, Willis J, Wolff RA, Kawaguchi Y, Vauthey JN, Sun R, Kopetz S, Shen JP. Survival improvement for patients with metastatic colorectal cancer over twenty years. NPJ Precis Oncol. 2023: 16 [PMID: 36781990, https://doi.org/10.1038/s41698-023-00353-4]
18. Santoro GA, Grossi U, Murad-Regadas S, Nunoo-Mensah JW, Mellgren A, Di Tanna GL, Gallo G, Tsang C, Wexner SD, Group D-C. DElayed COloRectal cancer care during COVID-19 Pandemic (DECOR-19): Global perspective from an international survey. Surgery. 2021: 796 [PMID: 33353731, https://doi.org/10.1016/j.surg.2020.11.008]
19. Moss JL, Roy S, Shen C, Cooper JD, Lennon RP, Lengerich EJ, Adelman A, Curry W, Ruffin MTt. Geographic Variation in Overscreening for Colorectal, Cervical, and Breast Cancer Among Older Adults. JAMA Netw Open. 2020: e2011645 [PMID: 32716514, https://doi.org/10.1001/jamanetworkopen.2020.11645]
20. Worthington J, Sun Z, Fu R, Lew JB, Chan KKW, Li Q, Eskander A, Hui H, McLoughlin K, Caruana M, Peacock S, Yong JHE, Canfell K, Feletto E, Malagon T. COVID-related disruptions to colorectal cancer screening, diagnosis, and treatment could increase cancer Burden in Australia and Canada: A modelling study. PLoS One. 2024: e0296945 [PMID: 38557758, https://doi.org/10.1371/journal.pone.0296945]
21. Star J, Han X, Smith RA, Schafer EJ, Jemal A, Bandi P. Cancer Screening 3 Years After the Onset of the COVID-19 Pandemic. JAMA. 2025: 1543 [PMID: 40042865, https://doi.org/10.1001/jama.2025.0902]
22. Carroll CB, Rotter SL, LoConte NK. Insights on colorectal cancer mortality trends between 1999-2022 in the US: the importance of place and sex. J Gastrointest Oncol. 2025: 327 [PMID: 40115926, https://doi.org/10.21037/jgo-2025-93]
23. Majek O, Gondos A, Jansen L, Emrich K, Holleczek B, Katalinic A, Nennecke A, Eberle A, Brenner H, Group GCSW. Sex differences in colorectal cancer survival: population-based analysis of 164,996 colorectal cancer patients in Germany. PLoS One. 2013: e68077 [PMID: 23861851, https://doi.org/10.1371/journal.pone.0068077]
24. Jackson SS, Marks MA, Katki HA, Cook MB, Hyun N, Freedman ND, Kahle LL, Castle PE, Graubard BI, Chaturvedi AK. Sex disparities in the incidence of 21 cancer types: Quantification of the contribution of risk factors. Cancer. 2022: 3531 [PMID: 35934938, https://doi.org/10.1002/cncr.34390]
25. Wu Z, Huang Y, Zhang R, Zheng C, You F, Wang M, Xiao C, Li X. Sex differences in colorectal cancer: with a focus on sex hormone-gut microbiome axis. Cell Commun Signal. 2024: 167 [PMID: 38454453, https://doi.org/10.1186/s12964-024-01549-2]
26. Koo JH, Leong RW. Sex differences in epidemiological, clinical and pathological characteristics of colorectal cancer. J Gastroenterol Hepatol. 2010: 33 [PMID: 19874446, https://doi.org/10.1111/j.1440-1746.2009.05992.x]
27. Zheng S, Schrijvers JJA, Greuter MJW, Kats-Ugurlu G, Lu W, de Bock GH. Effectiveness of Colorectal Cancer (CRC) Screening on All-Cause and CRC-Specific Mortality Reduction: A Systematic Review and Meta-Analysis. Cancers (Basel). 2023: [PMID: 37046609, https://doi.org/10.3390/cancers15071948]
28. Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019: 1467 [PMID: 31631858, https://doi.org/10.1016/S0140-6736(19)32319-0]
29. Sineshaw HM, Ng K, Flanders WD, Brawley OW, Jemal A. Factors That Contribute to Differences in Survival of Black vs White Patients With Colorectal Cancer. Gastroenterology. 2018: 906 [PMID: 29146523, https://doi.org/10.1053/j.gastro.2017.11.005]
30. Carethers JM. Screening for colorectal cancer in African Americans: determinants and rationale for an earlier age to commence screening. Dig Dis Sci. 2015: 711 [PMID: 25540085, https://doi.org/10.1007/s10620-014-3443-5]
31. Alexander D, Jhala N, Chatla C, Steinhauer J, Funkhouser E, Coffey CS, Grizzle WE, Manne U. High-grade tumor differentiation is an indicator of poor prognosis in African Americans with colonic adenocarcinomas. Cancer. 2005: 2163 [PMID: 15816050, https://doi.org/10.1002/cncr.21021]
32. Kamath SD, Torrejon N, Wei W, Tullio K, Nair KG, Liska D, Krishnamurthi SS, Khorana AA. Racial disparities negatively impact outcomes in early-onset colorectal cancer independent of socioeconomic status. Cancer Med. 2021: 7542 [PMID: 34647438, https://doi.org/10.1002/cam4.4276]
33. Glisan A, Nielsen E, Billion T, Abdul Jabbar AB, Avula A, Mirza M, Tauseef A. Regional trends in colorectal cancer mortality in people aged 45-84 years in the US, 1999-2022. J Gastrointest Oncol. 2024: 2533 [PMID: 39816027, https://doi.org/10.21037/jgo-24-624]
34. Prevention CfDCa. Adult Obesity Maps. Available from: https://www.cdc.gov/obesity/data-and-statistics/adult-obesity-prevalence-maps.html.
35. Sonal S, Jain B, Bajaj SS, Dee EC, Boudreau C, Cusack JC, Kunitake H, Goldstone R, Bordeianou LG, Cauley Md CE, Francone TD, Ricciardi R, Qadan M, Berger DL. Trends and Determinants of Location of Death Due to Colorectal Cancer in the United States : A Nationwide Study. Ann Surg Oncol. 2024: 1447 [PMID: 37907701, https://doi.org/10.1245/s10434-023-14337-y]
36. Quan Vega ML, Chihuri ST, Lackraj D, Murali KP, Li G, Hua M. Place of Death From Cancer in US States With vs Without Palliative Care Laws. JAMA Netw Open. 2023: e2317247 [PMID: 37289458, https://doi.org/10.1001/jamanetworkopen.2023.17247]
37. Davies JM, Sleeman KE, Leniz J, Wilson R, Higginson IJ, Verne J, Maddocks M, Murtagh FEM. Socioeconomic position and use of healthcare in the last year of life: A systematic review and meta-analysis. PLoS Med. 2019: e1002782 [PMID: 31013279, https://doi.org/10.1371/journal.pmed.1002782]
38. Chino F, Kamal AH, Leblanc TW, Zafar SY, Suneja G, Chino JP. Place of death for patients with cancer in the United States, 1999 through 2015: Racial, age, and geographic disparities. Cancer. 2018: 4408 [PMID: 30343501, https://doi.org/10.1002/cncr.31737]
39. Yabroff KR, Han X, Zhao J, Nogueira L, Jemal A. Rural Cancer Disparities in the United States: A Multilevel Framework to Improve Access to Care and Patient Outcomes. JCO Oncol Pract. 2020: 409 [PMID: 32574130, https://doi.org/10.1200/OP.20.00352]
40. Sauer AG, Siegel RL, Jemal A, Fedewa SA. Updated Review of Prevalence of Major Risk Factors and Use of Screening Tests for Cancer in the United States. Cancer Epidemiol Biomarkers Prev. 2017: 1192 [PMID: 28515109, https://doi.org/10.1158/1055-9965.EPI-17-0219]
41. Chow CJ, Al-Refaie WB, Abraham A, Markin A, Zhong W, Rothenberger DA, Kwaan MR, Habermann EB. Does patient rurality predict quality colon cancer care?: A population-based study. Dis Colon Rectum. 2015: 415 [PMID: 25751798, https://doi.org/10.1097/DCR.0000000000000173]
42. Paquette I, Finlayson SR. Rural versus urban colorectal and lung cancer patients: differences in stage at presentation. J Am Coll Surg. 2007: 636 [PMID: 17964438, https://doi.org/10.1016/j.jamcollsurg.2007.04.043]
43. Fu MS, Pan SX, Cai XQ, Pan QC. Urban vs. rural: colorectal cancer survival and prognostic disparities from 2000 to 2019. Front Public Health. 2024: 1319977 [PMID: 38406503, https://doi.org/10.3389/fpubh.2024.1319977]
44. Sepassi A, Li M, Zell JA, Chan A, Saunders IM, Mukamel DB. Rural-Urban Disparities in Colorectal Cancer Screening, Diagnosis, Treatment, and Survivorship Care: A Systematic Review and Meta-Analysis. Oncologist. 2024: e431 [PMID: 38243853, https://doi.org/10.1093/oncolo/oyad347]
45. Lee KMN, Hunleth J, Rolf L, Maki J, Lewis-Thames M, Oestmann K, James AS. Distance and Transportation Barriers to Colorectal Cancer Screening in a Rural Community. J Prim Care Community Health. 2023: 21501319221147126 [PMID: 36594346, https://doi.org/10.1177/21501319221147126]
46. Haakenstad A, Hawkins SS, Pace LE, Cohen J. Rural-urban disparities in colonoscopies after the elimination of patient cost-sharing by the Affordable Care Act. Prev Med. 2019: 105877 [PMID: 31669176, https://doi.org/10.1016/j.ypmed.2019.105877]
47. Murphy CC, Lee JK, Liang PS, May FP, Zaki TA. Declines in Colorectal Cancer Incidence and Mortality Rates Slow Among Older Adults. Clin Gastroenterol Hepatol. 2024: 416 [PMID: 37308035, https://doi.org/10.1016/j.cgh.2023.05.033]
48. Jafari MD, Jafari F, Halabi WJ, Nguyen VQ, Pigazzi A, Carmichael JC, Mills SD, Stamos MJ. Colorectal Cancer Resections in the Aging US Population: A Trend Toward Decreasing Rates and Improved Outcomes. JAMA Surg. 2014: 557 [PMID: 24718844, https://doi.org/10.1001/jamasurg.2013.4930]
49. Wang Y, Huang X, Cheryala M, Aloysius M, Zheng B, Yang K, Chen B, Fang Q, Chowdary SB, Abougergi MS, Chen S. Global increase of colorectal cancer in young adults over the last 30 years: an analysis of the Global Burden of Disease Study 2019. J Gastroenterol Hepatol. 2023: 1552 [PMID: 37211529, https://doi.org/10.1111/jgh.16220]
50. Siegel RL, Jakubowski CD, Fedewa SA, Davis A, Azad NS. Colorectal Cancer in the Young: Epidemiology, Prevention, Management. Am Soc Clin Oncol Educ Book. 2020: 1 [PMID: 32315236, https://doi.org/10.1200/EDBK_279901]
51. Gausman V, Dornblaser D, Anand S, Hayes RB, O'Connell K, Du M, Liang PS. Risk Factors Associated With Early-Onset Colorectal Cancer. Clin Gastroenterol Hepatol. 2020: 2752 [PMID: 31622737, https://doi.org/10.1016/j.cgh.2019.10.009]
52. Bailey CE, Hu CY, You YN, Bednarski BK, Rodriguez-Bigas MA, Skibber JM, Cantor SB, Chang GJ. Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975-2010. JAMA Surg. 2015: 17 [PMID: 25372703, https://doi.org/10.1001/jamasurg.2014.1756]
53. Kong JC, Su WK, Ng CW, Guerra GR, Chakraborty J, Lutton N, Morris B, Gourlas P. Colorectal cancer in younger adults from a Bi-National Colorectal Cancer Audit registry. ANZ J Surg. 2021: 367 [PMID: 32856368, https://doi.org/10.1111/ans.16250]
54. Liao CK, Hsu YJ, Chern YJ, Yu YL, Lin YC, Hsieh PS, Chiang JM, You JF. Differences in characteristics and outcomes between early-onset colorectal cancer and late-onset colorectal cancers. Eur J Surg Oncol. 2024: 108687 [PMID: 39288563, https://doi.org/10.1016/j.ejso.2024.108687]
55. Willauer AN, Liu Y, Pereira AAL, Lam M, Morris JS, Raghav KPS, Morris VK, Menter D, Broaddus R, Meric-Bernstam F, Hayes-Jordan A, Huh W, Overman MJ, Kopetz S, Loree JM. Clinical and molecular characterization of early-onset colorectal cancer. Cancer. 2019: 2002 [PMID: 30854646, https://doi.org/10.1002/cncr.31994]
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Copyright (c) 2026 Mahmoud Tablawy, Alyaa Ahmed Ibrahim, Salma Ehab, Mohammad Rayyan Faisal , Maryam Saghir, Eshal Saghir, Abdelrhman H. Mohamed, Rodina Sharaf, Ahmed Atef Mohamed , Humam Al-Machtomi, Mina Nageh, Mohaimen Mohammed Al-Machtomi, Ahmed Tharwat Emara, Safeya Fawzi, Ahmed Ebrahim , Mahdi Ahmed, Amro Ali, Mohamed Fawzi Hemida