COVID-19–Relevant Insights Into the Elevated Risk of Accidental Injuries in Survivors of SARS and Their Relatives in Taiwan: Retrospective Cohort Study
Bibliographic record
Abstract
Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".