Epidemiology of Communication Difficulty in Saudi Arabia: A Population-Based Analysis Using the National Disability Survey

<b>Background:</b> Communication difficulty restricts education, healthcare, and social participation, yet population-level data for Saudi Arabia have been scarce. This study analysed the 2017 Saudi National Disability Survey to estimate prevalence, describe severity and demographic patterns, and identify factors linked to these difficulties. <b>Objectives:</b> We aimed to estimate national and regional prevalence, assess severity, and gender differences, and identify socio-demographic and disability-related correlates. <b>Methods</b>: A cross-sectional, two-stage stratified cluster sample of 33,575 households (weighted N = 20,408,362 citizens) provided self-reported data on communication difficulty and socio-demographics. Weighted frequencies described prevalence and multivariable logistic regression identified independent correlates. <b>Results:</b> Among all Saudi citizens, 7.1% reported at least one functional difficulty, and of this group 15.7%-equivalent to 1.1% of the total population (n = 226,510)-had a communication difficulty; within that communication difficulty stratum, (n = 185,508) (0.9% of all citizens) experienced it alongside additional impairments, whereas (n = 41,002) (0.2% of all citizens) reported communication difficulty in isolation. The communication difficulties exhibit significant regional variation, ranging from 0.45% in Najran to 1.55% in Aseer. Most cases were classified as being associated with some difficulty (72%); females were over-represented in the extreme category despite a modest male excess overall (adjusted odds ratio [AOR] = 1.09). Higher education, married status, and bilateral first-cousin marriage (AOR = 1.22) were associated with greater risk. Chronic disease (44%) and perinatal causes (13%) predominated, and 84% of cases co-occurred with at least one other disability. Independent predictors included a long duration (AOR = 4.18), disease or delivery-related cause, and consanguinity. <b>Conclusions</b>: Findings highlight geographically clustered need, genetic risk factors, and substantial multimorbidity, indicating the importance of region-specific screening, premarital counselling, and integrated rehabilitation within chronic disease services.