Dog bite injuries and armed conflict-related environmental stressors: a nationwide population-based time-series study

BACKGROUND: Dog bite injuries pose a substantial public health burden worldwide. Environmental and acoustic stressors may contribute to dog behavioral dysregulation. However, there are as yet no population-level studies evaluating whether the incidence of dog bites increases during periods of armed conflict. The present study was conducted in Israel where the population is routinely exposed to an episodic pattern of high-intensity conflicts (escalation) alternating with periods of calm (de-escalation), providing a unique natural experiment to examine the effect of environmental stressors on population-level modifiers of injury risk. METHODS: This nationwide retrospective observational study covered the decade from 2014 to 2025. Healthcare-encounter data were used to capture dog bite-related diagnoses in both hospital and community settings. Exposure to armed conflict-related environmental stress was operationalized using the number of civil defense sirens per month, categorized as none (0), low (< 500), or high (≥ 500) and aggregated by geographic region (North, Center, South). Monthly dog bite counts were modeled using negative binomial regression adjusted for region, seasonality, age group, sex, and socioeconomic status. Secondary outcomes were hospitalization within 7 days and surgical intervention within 30 days, reflecting injury severity. RESULTS: A total of 63,285 dog bite-related encounters were identified. Compared to months with no sirens, adjusted dog bite incidence increased by 15% during low-exposure months (incidence rate ratio [IRR] 1.15, 95% CI 1.13-1.18) and by 33% during high-exposure months (IRR 1.33, 95% CI 1.28-1.37), demonstrating a graded exposure-response association. High exposure was associated with increased odds of surgical intervention within 30 days (OR 1.09, 95% CI 1.02-1.16; P = 0.013). CONCLUSIONS: This study provides the first population-level evidence linking armed conflict-related environmental stressors to increased dog bite incidence, using a quantitative graded exposure measure rather than a binary conflict-period definition. Dog bite prevention and healthcare preparedness should be taken into consideration in civilian injury mitigation strategies during armed conflict.