Title: Global, Regional, and National Burden of Colorectal Cancer in the Elderly (Aged >60
Years): A Comprehensive Analysis Across 204 Countries and Territories (1990-2021)
Version: 1 Date: 07 Jun 2025
Reviewer's report:
I commend the authors for conducting a thorough and ambitious global analysis of CRC
trends in the elderly population using the GBD 2021 dataset. The manuscript presents a
robust epidemiological assessment with clear articulation of global, regional, and temporal
trends, supported by advanced statistical modeling techniques such as Joinpoint regression
and BAPC-INLA forecasting. The decomposition analysis offers valuable insights into how
population aging, growth, and epidemiological shifts have influenced CRC burden. However,
the manuscript would benefit from a more precise description of how elderly patients were
stratified and how age-standardization was executed, particularly in the context of international
comparability across differing population structures. Also, while the use of GBD data is
justified, the authors should acknowledge the limitations of relying solely on modeled estimates,
especially in low-resource regions where cancer registries are sparse or absent.
Moreover, while the Results section is numerically rich, the narrative could be enhanced by
drawing stronger comparisons between high- and low-SDI regions to better highlight global
disparities in CRC burden. A critical discussion of how future screening, treatment access,
and demographic shifts may differentially impact regions would strengthen the public health
relevance of the findings. Additionally, incorporating visual summaries such as trend heatmaps
or SDI-stratified forest plots may improve the clarity and reader engagement. For completeness,
I recommend the authors cite prior relevant population-based studies on CRC burden and
outcomes, particularly: Niu C, Zhang J, Sun M, Saeed H, Han Y, Okolo 3rd PI. Maternal and
perinatal outcomes of pregnant patients with colorectal cancer: a population-based study. J
Cancer Res Clin Oncol. 2023 Nov;149(15):14159-67. and Niu C, Zhang J, Lian J, Utsav J, Iyer
C, Low S, Saeed H, Zahid S, Okolo 3rd PI. Anatomical location, risk factors, and outcomes of
lower gastrointestinal bleeding in colorectal cancer patients: a national inpatient sample analysis
(2009–2019). Int J Colorectal Dis. 2023 Aug 4;38(1):205.
Title: Global, Regional, and National Burden of Colorectal Cancer in the Elderly (Aged >60
Years): A Comprehensive Analysis Across 204 Countries and Territories (1990-2021)
Version: 1 Date: 07 Jun 2025
Reviewer's report:
I commend the authors for conducting a thorough and ambitious global analysis of CRC
trends in the elderly population using the GBD 2021 dataset. The manuscript presents a
robust epidemiological assessment with clear articulation of global, regional, and temporal
trends, supported by advanced statistical modeling techniques such as Joinpoint regression
and BAPC-INLA forecasting. The decomposition analysis offers valuable insights into how
population aging, growth, and epidemiological shifts have influenced CRC burden. However,
the manuscript would benefit from a more precise description of how elderly patients were
stratified and how age-standardization was executed, particularly in the context of international
comparability across differing population structures. Also, while the use of GBD data is
justified, the authors should acknowledge the limitations of relying solely on modeled estimates,
especially in low-resource regions where cancer registries are sparse or absent.
Moreover, while the Results section is numerically rich, the narrative could be enhanced by
drawing stronger comparisons between high- and low-SDI regions to better highlight global
disparities in CRC burden. A critical discussion of how future screening, treatment access,
and demographic shifts may differentially impact regions would strengthen the public health
relevance of the findings. Additionally, incorporating visual summaries such as trend heatmaps
or SDI-stratified forest plots may improve the clarity and reader engagement. For completeness,
I recommend the authors cite prior relevant population-based studies on CRC burden and
outcomes, particularly: Niu C, Zhang J, Sun M, Saeed H, Han Y, Okolo 3rd PI. Maternal and
perinatal outcomes of pregnant patients with colorectal cancer: a population-based study. J
Cancer Res Clin Oncol. 2023 Nov;149(15):14159-67. and Niu C, Zhang J, Lian J, Utsav J, Iyer
C, Low S, Saeed H, Zahid S, Okolo 3rd PI. Anatomical location, risk factors, and outcomes of
lower gastrointestinal bleeding in colorectal cancer patients: a national inpatient sample analysis
(2009–2019). Int J Colorectal Dis. 2023 Aug 4;38(1):205.
Please review this paper.
user
Title: Global, Regional, and National Burden of Colorectal Cancer in the Elderly (Aged >60
Years): A Comprehensive Analysis Across 204 Countries and Territories (1990-2021)
Version: 1 Date: 07 Jun 2025
Reviewer's report:
I commend the authors for conducting a thorough and ambitious global analysis of CRC
trends in the elderly population using the GBD 2021 dataset. The manuscript presents a
robust epidemiological assessment with clear articulation of global, regional, and temporal
trends, supported by advanced statistical modeling techniques such as Joinpoint regression
and BAPC-INLA forecasting. The decomposition analysis offers valuable insights into how
population aging, growth, and epidemiological shifts have influenced CRC burden. However,
the manuscript would benefit from a more precise description of how elderly patients were
stratified and how age-standardization was executed, particularly in the context of international
comparability across differing population structures. Also, while the use of GBD data is
justified, the authors should acknowledge the limitations of relying solely on modeled estimates,
especially in low-resource regions where cancer registries are sparse or absent.
Moreover, while the Results section is numerically rich, the narrative could be enhanced by
drawing stronger comparisons between high- and low-SDI regions to better highlight global
disparities in CRC burden. A critical discussion of how future screening, treatment access,
and demographic shifts may differentially impact regions would strengthen the public health
relevance of the findings. Additionally, incorporating visual summaries such as trend heatmaps
or SDI-stratified forest plots may improve the clarity and reader engagement. For completeness,
I recommend the authors cite prior relevant population-based studies on CRC burden and
outcomes, particularly: Niu C, Zhang J, Sun M, Saeed H, Han Y, Okolo 3rd PI. Maternal and
perinatal outcomes of pregnant patients with colorectal cancer: a population-based study. J
Cancer Res Clin Oncol. 2023 Nov;149(15):14159-67. and Niu C, Zhang J, Lian J, Utsav J, Iyer
C, Low S, Saeed H, Zahid S, Okolo 3rd PI. Anatomical location, risk factors, and outcomes of
lower gastrointestinal bleeding in colorectal cancer patients: a national inpatient sample analysis
(2009–2019). Int J Colorectal Dis. 2023 Aug 4;38(1):205.
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