Public health determinants of life expectancy in Saudi Arabia: a multidimensional analysis of infant mortality, anemia, immunization, fertility, and health expenditure

The kingdom of Saudi Arabia (KSA) has witnessed substantial health transformation and growth over the past two decades in various. The relationship between life expectancy at birth and other economic and demographic factors has not been systematically explored within a holistic, multidimensional framework. This study aims to combine dimension reduction, temporal clustering, and dynamic time-series regression to build a coherent picture of how these conditions relate to LEB in Saudi Arabia. The study used the World Development Indicators (WDI) database for the period 2000–2023, with life expectancy at birth as the dependent variable. We analyzed LEB as the dependent variable against eight explanatory variables: infant mortality rate, Gross domestic product (GDP) per capita, current health expenditure per capita, and anemia prevalence among women of reproductive age, physician density, PM2.5 air pollution, DPT immunization coverage, and total fertility rate. Principal Component Analysis(PCA) was applied to the factors, and K-means clustering was applied to the same standardized indicators. The relationship between the composite Health-Development dimension and life expectancy was then estimated using an ARDL model, with lag orders selected by AIC; ARDL(2,1) was retained as primary. During 2000–2023, LEB averaged 76.05 ± 1.94 years, rising from 72.61 years in 2000 to 78.73 years in 2023, with a peak of 78.75 years in 2018. Infant mortality averaged 10.48 ± 4.70 per 1,000 live births (19.90 in 2000 to 4.90 in 2023). GDP per capita averaged US$22,616.18 ± 7,968.58 (range US$10,586.05 in 2002 to US$38,510.23 in 2022). Bounds testing provided strong cointegration evidence at the 5% level (F = 26.271, p < 0.001). ARDL bounds testing on the Akaike Information Criterion(AIC)-selected ARDL(2,1) provided strong cointegration evidence at the 5% level (F = 26.271), with a long-run multiplier of 0.842 and an error-correction rate of 36.4% per year. Current health expenditure averaged US$1,038.71 ± 476.84 per capita, anemia prevalence averaged 19.65 ± 1.81%, PM2.5 exposure averaged 70.03 ± 4.90 µg/m³, DPT coverage averaged 96.88 ± 1.19%, and fertility declined from 4.21 to 2.14 births per woman (mean 2.91 ± 0.54). Physicians per 1,000 averaged 2.06 ± 0.77. The PCA-derived Health–Development dimension (PC1) incorporated all eight indicators and explained 79.81% of total variance; loadings were physician density +0.390, infant mortality −0.389, anemia prevalence −0.384, fertility −0.383, health expenditure +0.377, GDP +0.375, PM2.5 +0.294, and DPT immunization +0.182. The long-run multiplier was 0.842 (95% CI 0.728–0.956, p < 0.001), indicating that a one-unit improvement in the composite Health–Development dimension was associated with a 0.842-year long-run increase in LEB. This study concludes that higher life expectancy in Saudi Arabia is associated with a broad spectrum of multidimensional health, demographic, and socioeconomic factors, rather than fiscal health expenditure alone. The analysis indicates a gradual developmental transition and a plausible long-run association, though these findings are presented as indicative rather than definitive causal proof. Future research should incorporate longer time-series or cross-country panel data, alongside disaggregated healthy life expectancy (HALE) metrics, to further validate these dynamics.