Dog bites in The Netherlands: A study of victims, injuries, circumstances and aggressors to support evaluation of breed specific legislation
Introduction
Dog bites are of serious concern to public health and safety. By the age of 12, more than half of the children in the USA are reported to have been bitten by a dog (Spiegel, 2000), and Belgium has an annual frequency of 22 bites per 1000 children (De Keuster et al., 2006). Furthermore, 15.6% of dogs in a Canadian veterinary caseload have shown lifetime bite behaviour (Guy et al., 2001).
The incidence of dog bites forms a pyramidal shape, with an estimated 670 hospitalisations, 16,000 Emergency Department (ED) visits, 21,000 other medical visits, and 187,000 non-medically treated bites for each US dog bite-related fatality (DBRF) (Weiss et al., 1998). In the USA, rates of 7.1 fatal bites per 100 million population per year have been cited (Langley, 2009, Sacks et al., 1996) and 15.8 per 1000 people for all bites (Gilchrist et al., 2008). In The Netherlands such comparative estimates have not been made, but several registers provide an insight into the incidence of fatal and non-fatal dog bite injuries, but with no information on bites that were not medically treated. If the data from these registers in 2009 are presented in the same way as Weiss et al. (1998), it appears that for each Dutch DBRF there are approximately 150 hospitalisations, 5000 ED visits and 36,000 visits to a family practice (FP).1,2 In the years between 1997 and 2006, the annual average incidence of DBRF in The Netherlands was approximately 9.1 per 100 million of population.3 Children appear over-represented in the upper parts of the dog bite pyramid for both DBRFs and non-fatal medically attended bites (Castrodale, 2007, Gilchrist et al., 2008, Horisberger et al., 2004, Langley, 2009, Ozanne-Smith et al., 2001, Rosado et al., 2009, Sacks et al., 1996), but children and adults are equally represented in the lower part of the pyramid, namely, the non-medically attended bite incidents (Gilchrist et al., 2008).
Legislation is frequently used in an attempt to reduce injuries and deaths from dog bites through breed specific legislation (BSL) or non-breed specific legislation (nBSL). BSL typically prohibits the breeding and ownership of certain breeds or types of dogs categorised as ‘dangerous’ or ‘aggressive’ and nBSL includes regulations to promote responsible dog-ownership (Rosado et al., 2007). The classification of breeds or types as ‘dangerous’ is generally based on attack record or aggressive potential (Collier, 2006).
For several reasons BSL has been increasingly criticised and deemed inappropriate and ineffective (AVMA, 2001, Collier, 2006, Horisberger et al., 2004, Klaassen et al., 1996, Kuhne and Struwe, 2006, Ledger et al., 2005). Firstly, obtaining a reliable attack record is complicated due to scarce data on the reference population, incomplete breed registration, incorrect breed-identification, the number of non-purebred dogs and the narrow scope of relevant studies (AVMA, 2001, Collier, 2006). Moreover, BSL is rarely based on such records (Mills and Levine, 2006, Rosado et al., 2007). Secondly, the view that aggressive potential is linked to dog breed is a point of serious concern as a dog’s tendency to bite or show aggressive behaviour depends on more than just genetics, and other factors such as heredity, experience, socialisation and training, health, and victim behaviour all play a role (AVMA, 2001). As such, it has been advocated that aggressive potential should be evaluated for dogs individually (Collier, 2006).
This paper presents the first part of a study that evaluated Dutch BSL, as requested by the Dutch government. BSL was enacted to reduce the incidence of dog bites, especially fatal attacks and serious attacks requiring medical care. As far as we know, this is the first scientific evaluation initiated by a government to evaluate BSL. The work was part of a larger series of studies that contributed to the abolition of BSL in The Netherlands.
To establish the necessary perspective, we made an inventory of the details of bite incidents and of the canine population in The Netherlands. We surveyed subscribers to a representative on-line panel of people who had been bitten by a dog in the preceding 24 months, including incidents that were not presented in public health records (Beck and Jones, 1985, De Keuster et al., 2006).
Section snippets
Surveys
Three retrospective cross-sectional surveys were conducted each using a representative database of 200,000 persons, managed by the Dutch research agency TNS NIPO.4 Surveys were conducted using computer-assisted self interviewing (CASI) in which respondents participated using their own personal computer, received a notification e-mail after which they completed the questionnaire at a self chosen moment and returned it via the Internet or a direct modem connection (Bronner
Results
In the second survey, 1078 responses could be included in our analyses and nine were dropped because the respondents had indicated that no dog bite incident had occurred. This reflected a response rate of 89% (Table 1). An annual incidence of dog bites of 8.30 (95% CI 7.69–8.91) per 1000 population was found. Men were over-represented (P < 0.05) and no difference existed between incidence for people up to 18 years of age and those who were 18 and older.
Of the 1078 respondents, 52% were male and
Discussion
As Table 3 shows, about 136,000 dog bite incidents occur annually in the Netherlands (8.3 per 1000 population), resulting in 40,000 individuals who are treated at FPs, 11,000 at EDs or polyclinics and 300 who are hospitalised. To compare these findings with those of Weiss et al. (1998) for the US, we estimated that for each Dutch DBRF, there would be 180 hospitalisations, 8000 ED visits, 29,000 other medical visits and 60,000 dog bite incidents that did not require medical attention. These
Conclusions
Attack records can be assessed using the methods described but it is important to appreciate that such records may not be suitable as a basis for the development of mitigation strategies because this would require the removal of a large proportion of the canine population. The circumstances of the incidents must be the starting point for developing a suitable strategy. Prevention strategies need to be effective in non-public as well as in public arenas and should address both dog owners and
Conflict of interest statement
None of the authors of this paper has a financial or personal relationship with other people or organisations that could inappropriately influence or bias the content of the paper.
Acknowledgements
We would like to thank the ‘committee of wise men’ for their help in designing this study. We acknowledge the Ministry of Agriculture, Nature and Food Quality for their financial support. Many thanks also to Linda McPhee for her professional support in preparing this paper and to Bas Engel, Willem Buist, Hilde Tobi, Joanne van der Borg and Matthijs Schilder for their help in the analyses. Finally, we thank all the people that contributed to the data collection in so many ways.
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