Background <p>Lower respiratory tract infections (LRIs) are the fourth leading cause of death globally, affecting all age groups and leading to over 2&#xa0;million deaths annually. Saudi Arabia faces a significant burden from LRIs, affecting more than 15% of the population each year. This study aims to provide an overview of LRI mortality, etiologies, and risk factors in Saudi Arabia from 1990 to 2021.</p> Method <p>Data on LRI mortality in Saudi Arabia from 1990 to 2021 were extracted from the 2021 edition of the Global Burden of Disease (GBD) Result Tool. The analysis encompassed mortality rates across all age groups, with particular emphasis on children under five and adults over 70. Four primary etiologies influenza, respiratory syncytial virus (RSV), Streptococcus pneumoniae, and Haemophilus influenzae type b (Hib) were examined, alongside 14 associated risk factors.</p> Results <p>The total LRI deaths in Saudi Arabia decreased by 6% from 1990 to 2021, with a significant reduction observed among children under five years old (96%). In contrast, LRI mortality among adults over 70 increased by 16% during the same period. The age-standardized mortality rate decreased by 47%, with significant reductions in deaths associated with pneumococcus and RSV. However, risk factors, such as smoking and ambient particulate matter pollution, showed minimal declines or even increased mortality rates in older adults.</p> Conclusion <p>Over the past three decades, Saudi Arabia has made significant progress in reducing LRI mortality, particularly among children under five. However, the increasing mortality rates among the elderly highlight the need for targeted interventions to address their unique vulnerabilities. Continued investment in public health infrastructure, vaccination coverage, and environmental health initiatives is essential for further reducing the burden of LRIs in Saudi Arabia.</p>