A Decade of Transformation, Epidemiological Trends, and Implications of Work-Related Injuries in Saudi Arabia, 2016–2026: A Retrospective Ecological Time-Trend Analysis

Background: Work-related injuries (WRIs) represent a significant public health and economic burden globally and within the Kingdom of Saudi Arabia in particular.The period from 2016 to 2026 constitutes a highly consequential decade in Saudi Arabia's history, encompassing the launch of Saudi Vision 2030, sweeping labor market reforms, the disruption of the COVID-19 pandemic, and a period of accelerated postpandemic economic recovery and mega-project execution.This study describes national trends in registered WRI counts and rates among General Organization for Social Insurance (GOSI)-insured workers from 2016 to 2025, with Q1 2026 reported descriptively, and examines changes in injury characteristics where data are available.Methods: A retrospective ecological time-trend analysis was conducted using secondary open data from 86 quarterly and annual reports published by the GOSI.Data were extracted, translated, and harmonized.Descriptive statistics, linear regression, Mann-Kendall trend tests, Spearman correlation, and chi-square tests were employed to identify trends and statistically significant differences across four phases: pre-COVID (2016-2019), COVID-19 lockdown (2020-2021), post-COVID recovery (2022-2023), and the Vision 2030 growth (2024-2026).Results: A total of 345,792 WRIs were recorded among GOSI insured workers from 2016 through the first quarter of 2026.Annual injuries declined from 50,602 in 2016 to 28,813 in 2020, representing a 43.1% decrease, before reaching a COVID period low of 27,560 in 2021 and subsequently rebounding to 36,981 in 2025, a 34.2% increase from the 2021 low.The injury rate per 1,000 insured workers showed an overall statistically significant declining trend.Linear regression estimated a reduction of 0.281 injuries per 1,000 workers per year, explaining 76.1% of the variance in the annual injury rate (R2 = 0.761; F(1,8) = 25.54;p = 0.001).This downward trend was also supported by Spearman rank correlation (ρ = -0.927,p < 0.001) and the Mann-Kendall trend test (Z = -3.041,p = 0.002).The nationality distribution of injuries shifted significantly between 2016 and the 2024-Q1 2026 period (χ 2 = 673.69,p < 0.001), with the Saudi share increasing from 5.1% to 8.9%.The distribution of injury causes also changed significantly between Q1 2024 and Q1 2026 (χ 2 = 44.24,p < 0.001).Conclusion: While Saudi Arabia has achieved a substantial long-term reduction in occupational injury rates, the absolute number of injuries has increased significantly during the current economic acceleration.Continuous monitoring and targeted interventions, particularly for non-Saudi male workers in high-risk sectors, are necessary to sustain the safety improvements achieved before the pandemic.