Investigation of unreported multiple causes of death finds totals & “proximate cause” numbers very close to ours
RALEIGH, North Carolina––Marilyn Goss Haskell, DVM, and Ricky Lee Langley, M.D., both also holders of master’s degrees in public health, may never have heard of ANIMALS 24-7 and our log of fatal and disfiguring dog attacks in the U.S. and Canada, maintained since 1982.
But their study “Animal-Encounter Fatalities, United States, 1999-2016: Cause of Death and Misreporting,” recently published by Public Health Reports, the peer-reviewed journal of the Association of Schools and Programs of Public Health, provides an emphatic affirmation of the accuracy of the ANIMALS 24-7 approach to logging and classifying dog attack deaths.
(See Dog attack deaths & maimings, U.S. & Canada, 1982-2020 log. Updated editions are posted annually.)
How ANIMALS 24-7 logs deaths caused by dogs
The ANIMALS 24-7 policy, from the beginning of our logging, has been to log all deaths in which dogs are a proximate cause, with footnotes explaining unusual circumstances, such as deaths by heart attack, head injury, infection, or other accident apparently occurring as result of the victim having been under attack by a dog at the time.
Examples of the latter in the ANIMALS 24-7 log include 17 fatal heart attacks, 11 deaths from antibiotic-resistant infections transmitted by bites, three fatal strokes, three attacks by rabid dogs, three cases in which dogs strangled people by tugging on leashes or scarves, two fatal head injuries suffered when the victims were knocked down by pit bulls, and another suffered when the victim was knocked down by a Rottweiler, several cases in which the victim was hit by a car while dodging a dog attack, two cases in which a pit bull dragged a victim in front of a vehicle, and three deaths occurring when a weapon discharged to try to stop a potentially fatal dog attack in progress accidentally killed a victim who was already being severely mauled.
Taking unusual cases into account
From first publication of our findings, more than 30 years ago, pit bull advocates in particular have attacked our data for including such “proximate cause” deaths, even with the asterisks that enable the data users to quickly distinguish deaths caused directly by a dog’s jaws from other deaths caused by something a dog did.
(See Pit bulls & “proximate cause” deaths.)
The ANIMALS 24-7 response has always been simply that the victims are dead, and would not have been dead without the actions of the dog.
Understanding the total ecology of fatal dog attacks requires taking the unusual cases into account, as well as attacks following the most familiar patterns.
How ANIMALS 24-7 gets the data
The ANIMALS 24-7 data source, collated media coverage, typically incorporates information from police reports, animal control reports, witness accounts, victim accounts in most instances in which one or more victims of a dog attack survive, and hospital reports.
Media coverage is, in short, multi-sourced, unlike reports from any single source.
Critics of the ANIMALS 24-7 log of fatal and disfiguring dog attacks, again mostly pit bull advocates, have long argued that the use of media accounts as a data source is suspect because it does not come directly and exclusively from official public health records––which are often not immediately available, not breed-specific, not multi-sourced, and in the versions released in response to public records requests, not specific in identifying victims other than fatalities because of the privacy requirements of the Health Insurance Portability & Accountability Act of 1996.
Haskell & Langley worked from public health records
Marilyn Goss Haskell, DVM, and Ricky Lee Langley, M.D., approached essentially the same set of problems addressed by ANIMALS 24-7 from an altogether different direction, working entirely from official public health records.
Explained Haskell and Langley in their abstract, “Errors and misreporting on death certificates are common, along with potential inaccuracies in cause-of-death coding,” used by public health agencies to categorize deaths of all sorts.
“We characterized and compared fatalities by animal-encounter mentions reported as underlying cause of death,” Haskell and Langley said, “with animal-encounter mentions reported as multiple cause of death to determine factors associated with misreporting underlying cause of death.
“We analyzed fatality data from 1999-2016 from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research [WONDER],” Haskell and Langley elaborated.
Haskell and Langley then compared the WONDER data with “Multiple Cause of Death animal-encounter mentions” taken from International Classification of Diseases codes.
Deaths “may be under-reported”
Suggested Haskell and Langley, “Animal-encounter fatalities, analyzed by underlying cause of death alone, may be under-reported. An initiating animal injury, complicated by co-morbidities and fatality, may obscure the causal chain, resulting in misreporting underlying cause of death.”
Haskell and Langley looked at the entire spectrum of animal-encounter fatalities, not just fatal dog attacks, but dog attacks are by far the most common cause of deaths inflicted by mammals.
“The Centers for Disease Control and Prevention and the World Health Organization estimate that each year in the United States, dogs bite approximately 4.5 to 4.7 million people,” Haskell and Langley continued.
“Of these, nearly 885,000 [people] seek medical care, resulting in an average of 323,000 emergency department visits, 30,000 reconstructive procedures, and 10-20 fatalities,” Haskell and Langley wrote; but this fatality count, they discovered, is far low.
Multiple causes of death ignored
“One weakness of previously published studies of animal-encounter deaths in the United States,” Haskell and Langley observed, “is that only the underlying cause of death was reported and analyzed,” without attention to multiple causes contributing to deaths.
Thus, Haskell and Langley explained, “if a death certificate reported sepsis as the underlying cause of death when the injury that initiated the events resulting in death was an animal bite, the animal bite would not have been reported accurately with underlying cause of death analysis alone.”
This proved to be no mere hypothetical speculation.
“Of 77 animal-encounter mentions of dogs” in multiple cause of death reports, Haskell and Langley found, “18 (23%) decedents died of potential zoonotic infection, including 12 [deaths from] septicemia, three from pasteurellosis, and one from rabies.”
These numbers are all close to those discovered by ANIMALS 24-7 from combing news reports.
Over the years for which Haskell and Langley reviewed the data, 1999-2016, ANIMALS 24-7 logged 546 total U.S. deaths caused by dogs, 328 of them (60%) caused by pit bulls.
Haskell and Langley found 553 total U.S. deaths caused by dogs during that time frame in underlying cause of death reports, plus 42 more when multiple causes of death were taken into account, for a combined total of 595: 8% more than ANIMALS 24-7, which is to say that ANIMALS 24-7 found 92%, without having access to official cause of death reports not available until several years later.
ANIMALS 24-7 found that proximate causes accounted for 6% of U.S. dog-caused deaths from 1999 through 2016.
Haskell and Langley found that proximate cause deaths accounted for 7%.
“Under-reporting of risk & fatalities”
Wrote Haskell and Langley, “Our findings suggest that analyzing fatalities by underlying cause alone in CDC WONDER may result in under-reporting of risk and animal- encounter fatalities. We speculate that an initiating animal injury complicated by coexisting conditions (eg, heart disease, cancer, or infection) may trigger a cascade of morbid events leading to hospitalization and fatality, over-shadowing the true underlying cause of death and causal chain of events.”
Most of the fatalities that eluded ANIMALS 24-7 but were discovered by Haskell and Langley involved infections leading to deaths occurring days or weeks after the bite wounds that produced the infections.
“Of all animal bites, 3% to 18% of dog bites and 28% to 80% of cat bites become infected,” Haskell and Langley mentioned, footnoting studies that reported widely varying results.
Deaths from infection most likely to be overlooked
Overall, looking at all animal-related deaths, Haskell and Langley concluded, “Our study found that among 642 additional multiple cause of death animal-encounter mentions” in CDC WONDER data, “infections ranked second for underlying cause of death,” with the data pointing toward pasteurellosis, rabies, streptobacillus, and tularemia.
Thus, Haskell and Langley came to believe, deaths categorized as resulting from a zoonotic infectious disease are especially likely to be misreported in a manner that overlooks an animal bite as a multiple cause of death.
Cautioned Haskell and Langley in conclusion, “Our analysis reemphasizes the risk of fatal dog encounters among children aged less than four years old.
“Fatal dog encounters among children aged four or less are particularly concerning,” Haskell and Langley wrote, noting also the increased propensity of adults over 65 years old to have fatal encounters with reptiles, dogs, and other mammals.
“These findings support an exploration of targeted age group–based preventive education using a One Health approach,” Haskell and Langley suggested.
Jamaka Petzak says
Of course. Facts are facts and stats are stats. And LOST LIVES are LOST LIVES, due to DOG ATTACKS. Sharing to socials with gratitude, exasperation, and all of the other appropriate emotions.
I read all your reports and so many are graphic descriptions of death by dog. I hate to say it but it would be a better and more complete story if you would offer how the dog owner failed the dog and the also attacked humans. People are so careless, they abuse their pets, starve their pets, do not provide a safe environment for them, allow them to be untrained or cruelly trained to be “watchdogs, allowed to run in packs. So few of these dogs are owned by responsible pet owners. I feel that it would be a tremendous add-on to your statistics if you could include ways to force the owners to make safety a top priority. I know that you are very concerned about shelter and rescue placements of pits when in actuality many are placed in great forever homes and do not kill anyone but lead the life of a pet dog just like other breeds. There is much importance of your fact telling and it could be even better because very often a human error has created a monster.
Merritt Clifton says
With due respect to Connie Mogul’s 50 years of experience as a shelter volunteer, the data pertaining to dog attacks in general and pit bull attacks in specific rejects each and every one of her assertions. For instance, Dutch researcher Jan Smith traced the histories of 46 dogs who committed fatal attacks in the U.S. and abroad in 2015, finding only 12 cases––eight of them abroad––in which the background of the dog was sufficiently unknown that there was even any possibility that the dog had ever been abused or neglected. Of the 29 U.S. pit bull fatalities that Smith examined, only five owners might fairly have been said to have “failed” their dogs up until the dog got loose or went on a rampage within the home and killed someone. (See last portion of Record 34 fatal pit bull attacks & 459 disfigurements in 2015.)
ANIMALS 24-7, in 39 years of logging the data on more than 10,700 fatal & disfiguring U.S. and Canadian dog attacks, including 865 human fatalities, has encountered only a handful of cases in which the dog or dogs (among them more than 7,500 pit bulls) were normally kept in a manner differing significantly from the norms of the community, i.e. kept chained outside as a watchdog. In rural areas where dogs are often allowed to run at large, most fatal attacks involve dogs running at large, but in urban areas, where dogs are almost always kept indoors, almost all fatal attacks either occur in the home or yard, typically killing a member of the household, or when the dog escapes from a home or yard to kill a passer-by.
Only if one defines owning a dog who kills or maims someone as inherently irresponsible could the vast majority of fatal and disfiguring dog attacks be ascribed to “irresponsible” owners. If this is the definition of “irresponsible,” then it is inescapable that about 75% of the “irresponsible” owners over the past 39 years have been among the 5% of dog owners who keep pit bulls.
Concerning the allegation that shelter pit bulls are often “placed in great forever homes,” reality is that the rate of adopted pit bulls failing in homes and being returned to shelters or rescues runs at upward of 33% of placements; the failure rate among non-bully breeds is under 10%.
The relevant human error begins with breeding pit bulls in the first place, and has been amplified by decades of the humane community trying to rid itself of an ever-growing glut of pit bulls in shelters by aggressively amplifying the myth that they can ever become safe family pets.
I can observe this from my front window on a daily basis. I have a neighbor with two dogs–one, a small companion breed, and the other, a very large fighting/guarding breed. These dogs are owned by the same people and live in the same environment, yet their behavior couldn’t be more different.
The big dog is so aggressive and territorial, it is utterly frightening. I won’t even go outside when it’s out. The little dog is mild mannered and friendly; it barely even barks–even when I’ve seen the big dog leaping on its back. I fully expect that the little dog will be seriously injured or killed one day. I don’t wish the same fate on me or my loved ones, so I give that whole household a wide berth.
Many people have had to restructure their whole lives due to their neighbors’ choice of pet.
There are so many dog monsters purposely created for the gaming industry that it does not matter WHAT humans do. The dogs play with children like they play with their toys, shaking and ravaging. They’re dogs and not that smart. Deep down all they really want is food and to mate. We failed dogs by making them pets in the first place, then we failed people by anthropomorphising dogs. That’s the big failure. You need to be rational. People have NEVER been forced into being responsible, not even in prison. This will not change, especially when it is largely a criminal element which owns game dogs for gambling and guarding purposes. People who are social and live in family communities are sometimes tricked into purchasing extras produced by the game dog industry, but responsible people generally know better than to own game breeds and bloodsport dogs in the first place. If they do, that is the real failure to themselves, the dog, and the community.
SHARON PAGE says
I earned my (unfinished) PhD minor in statistics, and have always trusted Animals 24/7’s estimates. Every time I’ve had the chance to check them against real-life data, they are spot on. This is just one more verification that this data is very trustworthy.