Tuberculosis burden in Saudi Arabia: retrospective analysis of national surveillance data, 2012–2024, with future forecasts

Abstract Saudi Arabia faces a major tuberculosis (TB) challenge, potentially amplified by a large expatriate population from endemic areas, yet long-term national analyses remain limited. A retrospective analysis of Ministry of Health surveillance data was conducted for 2012–2024. Temporal trends were evaluated using segmented regression, while spatial heterogeneity across 20 health regions was assessed using burden and incidence analyses; distributions by sex, nationality, age, and TB type were examined. Future TB incidence rates were projected to 2029 using ARIMA and exponential smoothing (ETS) models; given the small number of annual observations, these projections are exploratory. A total of 37,477 TB cases were reported. A 2013 change point was followed by a decline of about 70 cases per year to 2024. Incidence fell during the 2020 pandemic and is currently around 7–8 cases per 100,000 population, nationally. Burden was concentrated in Jeddah and Riyadh, while incidence analyses additionally identified Jazan’s elevated population-adjusted notification rate. Cases were more frequent among males (67.5–79.7%) and adults aged ≥ 15 years (~ 97% of notifications with age data); non-Saudi residents accounted for 42.0-57.5%, exceeding 50% in several years. Pulmonary TB comprised 73.6–79.0% of cases. Exploratory forecasts projected broadly stable incidence to 2029, with wide prediction intervals. Although TB burden has declined since 2013, national incidence has shown little further reduction after 2020. Exploratory forecasts suggest broadly stable incidence through 2029, although considerable uncertainty remains. Strengthened surveillance, targeted screening, and region-specific interventions are needed to advance WHO End TB targets.