Background Injury and illness surveillance in Paralympic athletes was implemented in the past. First studies reported high incidences but are often limited to rates per exposure.

Objective Survival and risk analysis of longitudinal data on health problems and their burden were performed.

Design Prospective observational study

Setting Surveillance of elite Paralympic athletes from May 2019 until February 2020.

Participants 85 German Paralympic athletes preparing for Tokyo 2020 were included. Six athletes dropped-out during the monitoring phase, leaving 79 athletes included in the evaluation (30 females; 49 males; age: 29.5±10.9 years).

Intervention Weekly completion of the Oslo Sports Trauma Research Center questionnaire on health problems using a web application.

Main Outcome Measurements Median time to first severe health problem, leading to time loss or restriction of full participation in training or competition, and hazard ratio (HR) depending on sex, age or impairment. Calculation of the burden (time loss days per athlete per year) of health problems.

Results 55 participants reported with a median time of 63 days (95%CI: 35–133) a severe health problem. Women had significantly (p=0.02) shorter median time to first health problem (35 days; 95%CI: 7–105) compared to men (98 days; 95%CI: 49–294) and nearly twice as high risk to sustain a severe health problem (HR: 1.88; 95%CI: 1.1–3.24). Age or impairment comparisons showed no significant differences. Injuries at the shoulder resulted in the highest burden with 6.5 time loss days per athlete per year followed by the hand (2.9) and trunk (2.6). Respiratory infections showed the highest burden with 5.2 time loss days per athlete per year followed by genitourinary illnesses (1.9) and infectious diseases (1.8).

Conclusion Sex but not age or impairment type showed significant differences on time to health problem and enhanced risks. Upper body injuries and respiratory infections generated high burden.