Objective To examine the current status and trends of colorectal cancer (CRC) burden among Chinese residents from 1990 to 2021.

Methods Data on CRC burden in China, Asia, and the global population from 1990 to 2021 were retrieved from the Global Burden of Disease database for descriptive analysis. An age-period-cohort model was employed to estimate the effects of age, period, and cohort on CRC mortality and to forecast changes in disease burden.

Results In 2021, China’s age-standardized mortality rate, prevalence rate, and DALY rate for CRC were higher than global and Asian averages. The estimated annual percentage changes (EAPC) from 1990 to 2021 were −0.49% (95%CI: −0.55% to −0.43%) for mortality, 3.17% (95%CI: 3.03%−3.31%) for prevalence, and −0.62% (95%CI: −0.71% to −0.54%) for DALYs. Areas with high and medium-high sociodemographic indexes (SDIs) showed significant decreases in standardized mortality and DALY rates, but these rates remained higher compared with other regions. CRC mortality increased with age in the Chinese population, more prominently in males than in females. Using the 2002–2006 period as a reference (RR=1), the period effect on CRC mortality risk for women was higher than that for men until 2004, after which it declined considerably. With the 1957 birth cohort as a reference (RR=1), CRC mortality risk generally decreased across subsequent birth cohorts. Predictions indicate that by 2035, the standardized prevalence rate will be 267.21 per 100 000, and the standardized mortality rate will be 12.29 per 100 000.

Conclusion From 1990 to 2021, China’s age-standardized CRC mortality and DALY rates have decreased, while the standardized prevalence rate has increased. These findings suggest the government to establish a comprehensive multi-level CRC prevention network.