Mazu Pilgrimages in Taiwan: The Epidemiology of a Moving Mass Gathering Religious Event with Long Distance and Duration

Introduction: Medical and disaster-related incidents associated with mass gatherings are increasingly recognized as important issues. Understanding the nature of these gatherings and implementing thorough disaster preparedness and well-planned response strategies are essential for mitigating potential impacts. Taiwan’s Mazu pilgrimage is one of the largest mass gatherings worldwide, involving rituals and processions spanning over 300 kilometers in 8 to 10 days. Few studies have examined the health impacts and influencing factors associated with such prolonged and long-distance pilgrimage movements. This study aims to assess the health impacts and associated factors of these events to inform future preparedness and response planning. Methods: We conducted a retrospective observational study of patients visiting the emergency department during the Mazu pilgrimage from 2018 to 2024, utilizing data from the Emergency Medical Resources Management System (EMRM), Ministry of Health and Welfare. The dataset includes variables such as date of emergency visit, gender, age, primary diagnosis, mode of transportation to the emergency department, triage level, and medical interventions. The primary outcome measured was the frequency of emergency department visits. Results: A total of 1,637 patients visited the ED during the Mazu pilgrimages from 2018 to 2024. The mean age of all patients was 49.1 years, with 813 (49.7%) being male. Among these patients, 819 (50.0%) were transported to the ED by ambulance, and 177 (10.8%) were triaged as TTAS level I or II. Regarding patient disposition, 1,469 patients (89.7%) were discharged without admission, and 132 (8.1%) were admitted to the general ward. Conclusion: For the Mazu pilgrimages in Taiwan, most patients visiting the ED presented with mild cases. Furthermore, the health impacts extended beyond EDs to the emergency medical service (EMS), which had to respond to the increased demand for ambulance transportation. Therefore, it is critical to effectively manage both prehospital EMS and emergency services in EDs to bridge potential treatment gaps.