Burden of colon and rectum cancer attributable to a diet high in red meat in the United States, 1990-2021.

Background: Colon and rectum cancer (CRC) remains a major cause of cancer mortality in the United States. Within the Global Burden of Disease (GBD) framework, high intake of red meat has been modeled as a dietary risk factor for CRC; however, population-level estimates of the associated CRC burden across time, age groups, and United States remain incompletely characterized. Methods: Using data from GBD 2021, we quantified CRC deaths and disability-adjusted life years (DALYs) attributable to high intake of red meat, as defined by the GBD comparative risk assessment framework, in the United States from 1990 to 2021. Trends in age-standardized mortality rates (ASMR) and DALY rates (ASDR) were evaluated using estimated annual percentage change (EAPC). State-level variation and age-specific patterns were also examined based on modeled population-level estimates. Results: In 2021, an estimated 12,053 CRC deaths were attributable to high red meat intake in the United States according to GBD modeling, with declining ASMR and ASDR (EAPCs: -1.69 and -1.38, respectively). Males exhibited higher ASMR (2.45 vs. 1.72) and ASDR (61.72 vs. 41.82) than females. California, Texas, and Florida accounted for the highest absolute numbers of deaths, whereas Mississippi, Louisiana, and West Virginia showed the highest age-standardized rates. Age-stratified analyses indicated increasing mortality rates among adults aged 25-49 years (EAPC for ASMR: 0.17), contrasting with declining trends in older age groups. Decomposition analysis suggested that population growth was the dominant contributor to increases in absolute mortality. Conclusion: Although age-standardized CRC mortality and DALY rates attributable to high red meat intake have declined at the population level, the rising burden among younger adults and persistent geographic disparities across states remain concerning. As these findings are derived from ecological, model-based GBD estimates and do not reflect individual-level associations or causal effects, they should be interpreted with caution. Further research using individual-level data and more comprehensive dietary risk assessments, including processed meat and other dietary factors, is warranted.