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Abstract Background The incidence of early‐onset colorectal cancer (EO‐CRC) has been consistently rising leading to a significant cancer burden among younger adults in Asian and Middle Eastern high‐income countries. The study aims to investigate the survival outcomes of EO‐CRC among high‐income Asian and Middle Eastern populations from 1990 to 2019 using the mortality‐to‐incidence ratio, with a focus on examining the differences in gender. Methods This is a systematic analysis of the Global Burden of Disease (GBD) 2019 study. We include individuals aged 15 to 49 years old in high‐income Asian and the Middle Eastern countries. The colorectal cancer mortality‐to‐incidence ratio (MIR) was calculated for both genders by dividing the age‐specific mortality rate per 100,000 for colorectal cancer by the age‐specific incidence rate per 100,000 for each nation in the sample for a given year. Results An overall decline in male and female MIR was observed from 1990 to 2019 in Asian and Middle Eastern countries. Ten out of thirteen Asian and Middle Eastern countries had a higher female MIR compared to their male counterparts. The global male MIR was found to be significantly higher than that of female (p‐value 0.008, coefficient estimate: 1.51). In Middle Eastern countries, Saudi Arabia had a significantly higher female MIR compared to their male counterparts (p