This study investigated the primary factors contributing to mortality in Saudi Arabia and proposed effective healthcare management strategies to reduce mortality, prevent avoidable deaths, and optimize healthcare delivery. The findings highlight that adults aged 65 years and older exhibit the highest mortality rates, primarily due to the prevalence of chronic diseases in this age group [19]. Non-communicable diseases (NCDs), including ischemic heart disease, stroke, neoplasms, kidney diseases, and diabetes mellitus, were identified as the leading causes of mortality. Gender disparities were observed, with males consistently exhibiting higher mortality rates than females. Additionally, the findings indicate a strong negative correlation between causes of death (NCDs) and mortality rates, suggesting that as the ranking of causes of death changes, mortality rates tend to shift in the opposite direction. This implies that while certain NCDs contribute significantly to overall mortality, others have a comparatively lower impact. The negative correlation may also reflect advancements in NCD management, for example, Saudi Arabia’s tobacco control policies have contributed to a reduction in smoking-related diseases, while initiatives such as the National Diabetes Prevention Program and the RASHAKA Program have helped mitigate key NCD risk factors like obesity and physical inactivity [20,21,22,23,24].
This phenomenon can be attributed to progress in reducing risk factors and efficiently controlling non-communicable diseases among the population. Research has shown that public health interventions can reduce mortality rates associated with diseases such as cancer, diabetes, and cardiovascular disease. However, the results can differ based on the circumstances and the type of programs [25]. For instance, the outcomes of different cancer prevention and screening methods varied significantly, depending on the specific kind of cancer [26]. Nevertheless, programs can potentially enhance results and reduce medical expenses by motivating individuals with chronic illnesses to adhere to their outpatient treatment and attend scheduled sessions [27].
Correlations and implications
The findings indicate that risk factors for NCDs, including physical inactivity, obesity, unhealthy diets, diabetes, and hypertension, are significant contributors to mortality in Saudi Arabia [28]. Approximately two-thirds of the population have low levels of physical activity, half are obese, and one-quarter have diabetes. These risk factors strongly correlate with high mortality rates from cardiovascular diseases (CVD), particularly ischemic heart disease and stroke [28].
The results also show that ischemic heart disease emerged as the leading cause of mortality, with males experiencing significantly higher rates than females. Several biological, behavioral, and sociocultural factors contribute to this disparity. Biologically, men have a higher baseline cardiovascular risk due to differences in sex hormones, with testosterone being linked to higher blood pressure and unfavorable lipid profiles, increasing susceptibility to cardiovascular disease (CVD) [29]. Conversely, estrogen in females provides a protective effect against CVD by promoting better lipid metabolism and vascular function, potentially delaying the onset of heart disease [29].
Behavioral factors also play a significant role in gender-based mortality differences. Males in Saudi Arabia have higher rates of smoking and physical inactivity, both of which are major risk factors for CVD, lung disease, and metabolic disorders [28, 30]. The 2019 Global Adult Tobacco Survey reported that 19.8% of Saudi males use tobacco, compared to only 3.4% of females [31]. Similarly, dietary habits differ between genders, with men consuming higher amounts of processed and high-fat foods, which contribute to obesity and metabolic syndrome [32].
Additionally, health-seeking behaviors differ between genders, with men being less likely to engage in preventive healthcare, attend regular screenings, or seek medical attention early in disease progression, leading to delayed diagnosis and poorer health outcomes [33].
Furthermore, obesity and diabetes exacerbate the risk of acute coronary syndromes and heart failure, with Saudi patients developing these conditions nearly a decade earlier than those in industrialized nations [34, 35]. The early onset of these conditions contributes to prolonged exposure to complications and increased mortality. Patients with diabetes have a 2 to 4 times higher risk of developing cardiovascular disease (CVD) compared to the general population [36], and Saudi Arabia ranks in the top 10 nations in terms of diabetes prevalence, as reported by the International Diabetes Federation Diabetes Atlas (8th edition) [37]. A study found that the total occurrence of obesity was extremely high in Saudi Arabia [38]. Highlighting the ineffectiveness of obesity prevention measures in the monarchy. Furthermore, certain risk factors have been associated with the rising incidence of obesity in the nation, such as a sedentary lifestyle and a growing tendency to calorie consumption [28].
Addressing these risk factors through targeted interventions, such as promoting physical activity, encouraging healthier dietary habits, and improving diabetes management, is critical to reducing the burden of CVD and other NCDs. Public health initiatives must prioritize modifiable behaviors to significantly reduce mortality rates.
Comparison to Global Trends
The findings align with global trends, as NCDs account for 74% of deaths worldwide, according to the World Health Organization (WHO) [1]. Similar to global patterns, cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases are the major contributors to mortality in Saudi Arabia. However, Saudi Arabia faces unique challenges, such as the earlier onset of CVD and its complications, attributed to the higher prevalence of diabetes, obesity, and physical inactivity. Comparisons to high-income countries such as Finland and Canada provide valuable benchmarks for improving Saudi initiatives. For instance, Finland’s population-wide strategies targeting smoking cessation, dietary improvements, and physical activity significantly reduced CVD mortality [39], while Canada’s comprehensive tobacco control policies and public education campaigns achieved similar outcomes [40].
Government initiatives
The Saudi government has implemented significant reforms under the Saudi Vision 2030 initiative, including the National Transformation Program, to improve healthcare quality and efficiency [28]. Specific measures targeting cardiovascular diseases (CVD) and other non-communicable diseases (NCDs) include the Saudi Guideline for Tobacco [20], the Obesity Control & Prevention Strategy 2030 [21], the RASHAKA Program promoting physical activity [22], the Saudi Hypertension Guideline [23], and the KSA National Strategy for Diet and Physical Activity [24]. Additionally, efforts to improve urban walkability through the City Humanization Initiative aim to encourage healthier lifestyles among the population [41].
These programs align with the World Heart Federation’s roadmap to reduce premature mortality from CVD by at least 25% by 2025 [42]. By benchmarking against successful international approaches, such as Finland’s North Karelia Project, which focused on population-wide interventions like smoking cessation, dietary improvements, and increased physical activity [39], and Canada’s integration of community-based interventions and tobacco control policies [40], Saudi Arabia can further strengthen its initiatives. Expanding preventive healthcare access, implementing stricter regulations on unhealthy food and beverages, and enhancing public awareness campaigns could support the country’s goals of reducing CVD mortality and achieving Vision 2030 objectives.
Challenges and recommendations
In Saudi Arabia, non-communicable diseases constitute the predominant disease burden [43]. The annual economic burden due to non-communicable diseases in Saudi Arabia is quantified at US$24.4 billion, with direct charges constituting 45% of this financial burden [44]. The strategic prioritization of healthcare expenditure in Saudi Arabia towards augmenting primary and preventive care is underscored by the pursuit of optimal efficiency and value for money. Primary Health Care Centers (PHCs) are critical in managing NCDs, yet their readiness to implement reforms requires further evaluation [45]. Specialized chronic disease clinics and the introduction of Electronic Health Records (EHRs) have improved care delivery; however, current EHR systems lack full functionality, such as providing patients complete access to their health information. Additionally, PHCs need enhanced resources to support nutrition and physical activity counseling [46]. Financial barriers can also hinder effective chronic disease management [47, 48]. Despite the Saudi government providing free healthcare to its citizens, the current funding model faces significant challenges in ensuring financial sustainability. The system is under immense pressure because of the rising costs associated with managing NCDs and the increasing demand for healthcare due to population growth and aging.
Reforms are being implemented as part of Saudi Vision 2030, emphasizing the introduction of private health insurance to alleviate the financial burden on the public healthcare system. However, the current private health insurance model focuses primarily on treatment rather than prevention, limiting its effectiveness in addressing NCDs comprehensively [49].
Saudi Arabia could adopt successful strategies from other high-income countries to address these challenges. For instance, France exempts individuals with chronic conditions from co-payments, ensuring financial accessibility [50]. Germany caps out-of-pocket healthcare costs at 1% of annual income for patients with chronic illnesses [51]. Implementing similar financial protections in Saudi Arabia, such as capped expenses or targeted subsidies, could enhance healthcare equity and improve outcomes for patients with NCDs. These measures would also align with Vision 2030’s goals of promoting health equity and improving population health outcomes.
Study Limitations
The study faced limitations due to the lack of comprehensive WHO data on mortality causes in Saudi Arabia beyond 2020. This gap restricts the ability to analyze recent trends and assess the impact of recently implemented public health initiatives.
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