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Sport, sex and age increase risk of illness at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days
  1. Wayne Derman1,2,
  2. Martin P Schwellnus2,3,
  3. Esme Jordaan4,5,
  4. Phoebe Runciman1,2,
  5. Cheri Blauwet6,
  6. Nick Webborn7,
  7. Jan Lexell8,9,10,
  8. Peter Van de Vliet11,
  9. Yetsa Tuakli-Wosornu12,
  10. James Kissick13,
  11. Jaap Stomphorst14
  1. 1 Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, South Africa
  2. 2 International Olympic Committee (IOC) Research Centre, South Africa
  3. 3 Sport, Exercise Medicine and Lifestyle Institute (SEMLI) and Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  4. 4 Biostatistics Unit, Medical Research Council of South Africa, Cape Town, South Africa
  5. 5 Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
  6. 6 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  7. 7 Centre for Sport and Exercise Science and Medicine (SESAME), University of Brighton, Eastbourne, UK
  8. 8 Department of Health Sciences, Lund University, Lund, Sweden
  9. 9 Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
  10. 10 Department of Health Science, Luleå University of Technology, Luleå, Sweden
  11. 11 Medical and Scientific Department, International Paralympic Committee, Bonn, Germany
  12. 12 Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
  13. 13 Carleton University Sport Medicine Clinic, Department of Family Medicine, University of Ottawa, Ontario, Canada
  14. 14 Department of Sports Medicine, Isala Klinieken, Zwolle, The Netherlands
  1. Correspondence to Professor Wayne Derman, Division of Orthopaedic Surgery, Faculty of Medicine and Health Science, Institute of Sport and Exercise Medicine, Stellenbosch University, Francie van Zijl Drive, Bellville, Cape Town, 7505, South Africa; ewderman{at}


Objective To describe the epidemiology of illness at the Rio 2016 Summer Paralympic Games.

Methods A total of 3657 athletes from 78 countries, representing 83.5% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system (WEB-IISS) over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Illness data were obtained daily from teams with their own medical support through the WEB-IISS electronic data capturing systems.

Results The total number of illnesses was 511, with an illness incidence rate (IR) of 10.0 per 1000 athlete days (12.4%). The highest IRs were reported for wheelchair fencing (14.9), para swimming (12.6) and wheelchair basketball (12.5) (p<0.05). Female athletes and older athletes (35–75 years) were also at higher risk of illness (both p<0.01). Illnesses in the respiratory, skin and subcutaneous and digestive systems were the most common (IRs of 3.3, 1.8 and 1.3, respectively).

Conclusion (1) The rate of illness was lower than that reported for the London 2012 Summer Paralympic Games; (2) the sports with the highest risk were wheelchair fencing, para swimming and wheelchair basketball; (3) female and older athletes (35–75 years) were at increased risk of illness; and (4) the respiratory system, skin and subcutaneous system and digestive system were most affected by illness. These results allow for comparison at future Games.

  • disability
  • illness
  • athlete
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  • Contributors Please find attached the completed COI forms from all authors.

  • Funding This study was approved and supported by the International Paralympic Committee. Funding for the study was provided by the International Olympic Committee Research Centre (South Africa) Grant.

  • Competing interests None declared.

  • Ethics approval Before research activities were started, approval was granted by the University of Brighton (FREGS/ES/12/11) and Stellenbosch University (N16/05/067) Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data gathered for this study are extensive and this paper as well as the accompanying paper on injuries form the first two primary papers. The data are available for members of the IPC medical commission for secondary analyses. Such studies are ongoing between games.

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