Objective To analyze trends in the burden of colorectal cancer in China from 1994 to 2023, providing evidence for colorectal cancer prevention and control. MethodsData on colorectal cancer incidence, mortality, and disability-adjusted life year (DALY) in China were obtained from the Global Burden of Disease 2023. Joinpoint regression was used to estimate the average annual percentage change (AAPC) and annual percentage change (APC). Age-period-cohort models were applied to estimate age, period, and birth cohort effects. Lagged correlation analysis was performed to assess the temporal association between burden of incidence and mortality. ResultsIn 2023, there were 611 364 colorectal cancer cases and 257 480 deaths in China, which increases 185.98% and 72.72%, respectively, compared with the year 1994. The crude incidence rate increased from 17.41 per 100 000 to 42.73 per 100 000 and the crude mortality rate from 12.14 per 100 000 to 18.00 per 100 000, which increase 145.43% and 48.27%, respectively. Over the same period, the age-standardized incidence rate (ASIR) increased from 22.18 per 100 000 to 26.60 per 100 000, whereas the age-standardized mortality rate (ASMR) decreased from 16.26 per 100 000 to 11.42 per 100 000 and the age-standardized DALY rate decreased from 429.75 per 100 000 to 281.61 per 100 000. The results of Joinpoint regression analysis showed that from 1994 to 2023, the overall change in ASIR was not statistically significant (AAPC=0.75%, P>0.05), whereas the ASMR and age-standardized DALY rate decreased (AAPCs were ?1.16% and ?1.38%, respectively; P<0.05). From 2020 to 2023, all 3 four indicators(ASIR, ASMR, standardized DALY rate)increased (APC were 5.89%, 3.92%, and 4.05%, respectively; P<0.05). The ASIR increased among males (AAPC=1.31%, P<0.001) but there were no significant differences in among females (AAPC=?0.19%, P>0.05). From 2020 to 2023, the ASMR increased significantly among males (APC=4.65%, P<0.01) but there were no significant differences in among females (APC=3.95%, P>0.05). Age effects showed that incidence, mortality, and DALY rates peaked at ages 85–89, 90–94 and 75–79 years, respectively. Period effects showed that the incidence rate ratio (RR) among males was highest in 2019–2023 [RR=1.08, 95%CI (1.04, 1.13)], whereas the mortality and DALY rate RRs for the overall population remained below those of the reference period (2004–2008). Cohort effects showed incidence RRs increased firstly and then decreased as year of birth gose by. Incidence and mortality were most strongly correlated at a lag of 0 years [r=0.993, 95%CI (0.985, 0.997)]. ConclusionsThe past 30 years, the burden of colorectal cancer in China increased substantially, whereas the ASMR and age–standardized DALY rate declined overall. The burden remained high among the aged, and changes among males and more recent birth cohorts warrant particular attention. The increases in several age-standardized measures during 2020–2023 underscore the need for continued surveillance of colorectal cancer burden and targeted prevention and control strategies.