Abstract: Objective To analyze the disease burden of colorectal cancer (CRC) attributed to fasting hyperglycemia in China from 1990 to 2021 and to project trends for the period 2022 to 2036, thereby providing a scientific basis for CRC prevention strategies in China. Methods Relevant data were extracted from the Global Burden of Disease 2021(GBD2021) database. The trend analysis of mortality, age⁃standardized mortality rate (ASMR), disability⁃adjusted life years (DALYs), and age⁃standardized DALYs rates (ASDR) were performed using the Joinpoint regression model. The age, period and cohort effects of CRC attributed to fasting hyperglycemia were examined using an age⁃period⁃cohort model. Additionally, the Autoregressive Integrated Moving Average (ARIMA) model was utilized to project trends in the disease cases, ASMR and ASDR from 2022 to 2036. Results Compared to 1990, the number of CRC deaths, ASMR, DALYs and ASDR attributable to fasting hyperglycemia in China in 2021 increased by 192.88%, 3.45%, 162.27%, and 4.49%, respectively, with an average annual increase of 0.25% for ASMR and 0.24% for ASDR. The disease burden was higher among males than females. The age effect revealed that the CRC mortality attributable to fasting hyperglycemia in China peaked in the 90-94 age group, while the DALYs rate peaked in the 85-89 age group. The period effect indicated that the period relative risk (RR) of mortality initially increased, followed by a slight wave⁃like trend over time, whereas the period RR of the DALYs rate initially increased, stabilized, and then rose again over time. The cohort effect demonstrated that the cohort RR for both mortality and DALYs rate initially decreased and then fluctuated upward over time. The predicted results indicated that the number of CRC deaths attributable to fasting hyperglycemia in China will decrease from 18,440 in 2021 to 5,144 in 2036. Similarly, the ASMR is projected to decline from 0.90/105 in 2021 to 0.84/105 in 2036. Additionally, the ASDR is expected to decrease from 20.25 /105 in 2021 to 18.85/105 in 2036. Conclusions The number of CRC deaths, ASMR, DALYs, and ASDR attributed to fasting hyperglycemia in China from 1990 to 2021 exhibited an increasing trend, partially influenced by age, period, and cohort effects. In the future, it is essential to strengthen glycemic control among high⁃risk groups, such as men and the elderly, and to prioritize CRC health education and awareness to reduce the disease burden.

Key words: Colorectal cancer, Fasting hyperglycemia, Disease burden, Age?period?cohort model, Prediction