Overall, the Pomeranian is a sturdy, healthy dog. The most common health issues are luxating patella and tracheal collapse. As of 2013, in terms of registration figures, since at least 1998, the breed has ranked among the top fifty most popular breeds in the US, and the current fashion for small dogs has increased their popularity worldwide. It is more popular in American cities in 2008, ranking joint tenth (with American Bulldog) in Detroit and Orlando, ninth in Los Angeles, a joint seventh in Seattle (again, with the American Bulldog), but third in Honolulu, only bested by the Labrador Retriever and the German Shepherd.