BACKGROUND: Injury can be a devastating setback for elite athletes whereby injury prevention plays a key role in the biography of athletes. This study had three aims: 1) to compare if there are differences between German and Taiwan elite athletes in injury-related factors; 2) to evaluate the influence of these factors to injury frequency; and 3) to identify possible interactions within injury-related factors and the injury risk for both cohorts. METHODS: A total of 335 elite athletes (269 Taiwanese athletes: 121 F, 148 M, mean age 23.2 +/- 6.9; 66 German athletes: 32 F, 34 M, mean age=26.0 +/- 7.6) participated. Inclusion criterion: current or retired national team members of Olympic sports. A risk of injury questionnaire (Risk-IQ) for elite athletes was used. Scores were calculated for individual scales/subscales for analysis. Descriptive statistics, independent sample t-tests, Spearman correlation, Mann-Whitney U test and Kruskal-Wallis ANOVA tests were employed. Generalized linear models for multivariate regression of scales/subscales were used. Significance was set for P<0.05. RESULTS: Hypothesis I : the results of medical care, environment, training, stress, and injury caused losses factors tested significantly different (all P<0.05) between German and Taiwanese cohorts. Hypothesis 2: regardless of nationality, the injury contributing factors were: age, sport types, experience levels, medical care, cardiovascular problem, training and stress (all P<0.05). Hypothesis 3: The interaction effect existed between sport type_format, injury caused losses and medical care. CONCLUSIONS: Injury-related influencing factors and interactions can be found via multi-disciplines integrated Risk IQ regardless of heterogeneous recruitment. The top 5 injury risk factors were: 1) experience level (international competition); 2) number of periodic health examination and pre-participation evaluation received; 3) sport types; 4) stress from life events; 5) age.