COVID-19–Relevant Insights Into the Elevated Risk of Accidental Injuries in Survivors of SARS and Their Relatives in Taiwan: Retrospective Cohort Study

TL;DR

This study found that SARS survivors and their relatives in Taiwan had higher long-term risks of accidental injuries, suggesting lasting physical and mental health effects from the 2003 outbreak.

Contribution

The study is the first to show long-term elevated injury risks in SARS survivors and their families, extending follow-up beyond 7 years and including both unintentional and intentional injuries.

Findings

SARS survivors had a 63% higher risk of accidental injuries compared to controls.

Relatives of survivors faced a 57% higher injury risk, possibly due to caregiving stress.

Subgroup analyses revealed increased risks for poisoning, falls, and traffic incidents in both groups.

Abstract

The 2003 outbreak of severe acute respiratory syndrome (SARS), caused by a novel coronavirus, heavily impacted Taiwan’s health care system, triggering clinical crises and lasting effects among affected individuals and families. The first case in Taiwan was identified on February 25, 2003, and the final case was reported on June 15, 2003. During the epidemic, 346 people were diagnosed with SARS, leading to 37 deaths. Outbreaks also occurred in China, Singapore, and Toronto (Canada), showing the vulnerability of global health systems to new zoonotic diseases. Clinically, SARS causes high fever and severe lung inflammation. Survivors often had long-term lung problems, including fibrosis, and bone issues like osteonecrosis, mostly due to high-dose steroid treatment. Although studies have looked at long-term outcomes—especially lung and bone issues—none followed patients beyond 7 years. The COVID-19 pandemic further revealed gaps in understanding how serious viral infections affect wider health areas, including unintentional and intentional injuries. Data on related hospitalizations also remain limited.

This study aimed to investigate the long-term risk of both unintentional and intentional injuries among survivors of SARS and their relatives, using a nationwide population-based cohort.

This retrospective cohort study used data from Taiwan’s National Health Insurance Research Database, focused on 285 individuals diagnosed with SARS in 2003 and 699 of their relatives, matched in a 1:10 ratio with controls. Injury risks were assessed using Fine and Gray’s competing risk models, adjusting for sociodemographic and clinical covariates, over a follow-up period of up to 15 years.

Survivors of SARS exhibited a significant increase in the risk of accidental injuries, with an adjusted hazard ratio (AHR) of 1.631 (95% CI 1.184-2.011; P<.001), indicating persistent physiological vulnerabilities postinfection. Family members of survivors of SARS also had elevated injury risk (AHR 1.572, 95% CI 1.148-1.927; P<.001), possibly due to stress and caregiving burdens. Subgroup analysis showed increased risks for poisoning (AHR 2.701, 95% CI 1.956-4.084; P<.001) and falls (AHR 1.524, 95% CI 1.102-1.878; P=.003) among survivors. Relatives faced higher risks for traffic incidents (AHR 2.003, 95% CI 1.462-2.459), poisoning (AHR 1.531, 95% CI 1.120-1.886), medical incidents, falls (AHR 1.802, 95% CI 1.324-2.214), and crushing injuries (AHR 2.469, 95% CI 1.803-3.026; all P<.001). These findings highlight the need for targeted preventive measures to address long-term health risks in both survivors of SARS and their families.

Survivors of SARS and their relatives face increased injury risks, highlighting long-term physical and psychosocial vulnerabilities after severe infectious outbreaks. These findings suggest that health care systems should provide preventive and supportive measures to mitigate long-term impacts for those affected by pandemics.

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