# Assessing health risks and preparedness strategies in mass-gathering religious events: a retrospective observational study

## TL;DR

This study examines health risks during large religious pilgrimages in Taiwan to help improve emergency preparedness.

## Contribution

The study identifies key factors like walking distance and temperature that influence health risks during mass-gathering events.

## Key findings

- Most emergency department visits during Mazu pilgrimages were for minor trauma-related injuries.
- Heat emergencies were linked to higher temperatures, and walking distance correlated with trauma cases.
- Start or end days of the pilgrimage were associated with increased emergency visits and specific injuries.

## Abstract

Mazu pilgrimages are among the largest moving religious events worldwide, involving ceremonies and processions spanning over 300 km in 8–10 days. The massive crowds pose unique public health challenges. This study aimed to assess the health risks and contributing factors of these events to help authorities and local healthcare services better anticipate, prepare for, and mitigate potential health issues during the pilgrimage.

We conducted a retrospective observational study using patient data from the Emergency Medical Resources Management System of Taiwan’s Ministry of Health and Welfare from 1 January 2018 to 31 October 2024. Records included demographics, means of transport, Taiwan Triage and Acuity Scale (TTAS) level, diagnosis, and disposition for each emergency department (ED) visit related to the two Mazu pilgrimages. Individual ED visits were aggregated into daily counts to estimate daily health impacts. The primary outcome was the daily total number of pilgrimage-related ED visits; secondary outcomes were daily counts for specific diagnoses. Multivariable linear regression was used to examine associations between environmental and event-related factors—including whether the day was the start or end day of the pilgrimage (S-or-E-day), daily walking distance, highest temperature, and relative humidity—and the log-transformed daily ED visit and diagnosis-specific counts.

A total of 1,637 patients visited the ED during Mazu pilgrimages in the study period. Half arrived by ambulance, and 10.8% were triaged as TTAS I/II. Most patients (89.7%) were discharged without admission; only 8.1% were admitted to general wards. Trauma-related diagnoses were the most common (53.7%), with soft tissue injuries (28.1%) and heat emergencies (16.1%) being the most frequent trauma and non-trauma conditions, respectively. The S-or-E-day variable was significantly associated with the daily number of ED visits, trauma, head injuries, orthopaedic injuries, and heat emergencies. Walking distance was linked to ED visits and trauma cases, while highest temperature was linked to heat emergencies.

During Mazu pilgrimages in Taiwan, most patients visiting the ED presented with mild conditions, predominantly minor trauma-related injuries. By monitoring walking distance and temperature, healthcare providers can better anticipate and prepare for cases related to trauma and heat emergencies.

Not applicable.

The online version contains supplementary material available at 10.1186/s12873-025-01293-x.