Time Trend and Association of Early-Onset Colorectal Cancer with Diverticular Disease in the United States: 2010–2021

SIMPLE SUMMARY: The incidence of early-onset colorectal cancer (EOCRC; in patients <50 years old) has increased at an alarming rate. Diverticular disease is a common condition that can lead to inflammation of the colon. EOCRC and diverticular disease share many risk factors and are regarded as diseases of western civilization. We aimed to examine time trends of incidence rates of EOCRC from 2010 to 2021 among patients with and without preexisting diverticular disease and investigated whether diverticular disease is associated with increased risk of EOCRC. We show that the incidence of diverticular disease continuously increased from 2010 through 2021, and that diverticular disease is a significant risk factor for EOCRC. Our findings call for careful monitoring of EOCRC among patients with pre-existing diverticular disease and for more mechanistic research of the observed associations. ABSTRACT: Purpose: To examine time trends of incidence rates of EOCRC from 2010 to 2021 among patients with and without diverticular disease and to examine whether diverticular disease is associated with increased risk of EOCRC. Methods: This is a retrospective cohort study of 46,179,351 young adults aged 20–49, including 298,117 with diverticular disease. We examined yearly incidence rate of first diagnosis of EOCRC from 2010 through 2021 among patients with and without diverticular disease. The 5-year risk of EOCRC among patients with pre-existing diverticular disease was compared to propensity-matched patients without diverticular disease and EOCRC and odds ratio (OR) and 95% confidence interval (CI) were calculated. Results: The yearly incidence rate of new diagnosis of EOCRC (measured as new cases per 100,000 people per year) in young adults with pre-existing diverticular disease increased from 100 in 2010 to 402 in 2021, 4–6 times higher than in those without diverticular disease (24 in 2010 to 77 in 2021) (p < 0.001). Patients with diverticular disease were at higher risk for EOCRC than those without (OR: 1.76, 95% CI: 1.40–2.32). Conclusion: The incidence of EOCRC continuously increased from 2010 through 2021 in patients with and without diverticular disease and was 4–6 times higher among patients with diverticular disease. Patients with pre-existing diverticular disease were at a significantly increased risk for EOCRC.