Cardiovascular-related health behaviors and lifestyle during the COVID-19 pandemic: An infodemiology study

Abstract

Background: Reports have suggested decreasing attention to CVD comorbidities during the COVID-19 pandemic, despite their association with worse virus-related outcomes. Using nowcasting tools, we sought to explore temporal trends in public interest by studying use of online search terms related to CVD comorbidities during the pandemic time period.

Methods: We queried Google Trends for recent (October 2019-October 2020) and seasonal (October 2016-October 2020) trends of search terms pertaining to cardiovascular-related behaviors or clinical care including clinical diagnostic and therapeutic-related terms. Additionally, we acquired data from Google Shopping Insights to explore consumer behavior. Data for search results in the US were compared using mean relative search volumes (RSV), tabulated by month.

Results: Online search interest in the terms "Exercise" and "Cigarettes" changed by +18.0% and -52.5%, respectively, comparing March-April with January-February 2020. Key terms related to CVD-related care, including diagnostic and therapeutic-related terms such as "Statin", "Lipid profile", "Low-density lipoprotein", and "Hemoglobin A1C" declined to a four-year low in late March 2020 but regained pre-pandemic search query frequency by July 2020. Results were supported by Google Shopping analysis; for example, online consumer shopping-related searches for tobacco products reached at an all-year low after May 2020.

Conclusion: We report an increase in search interest for an overall healthier CVD-related lifestyle starting in March 2020, supported by online consumer shopping behavior. However, a months-long trough in public interest for CVD care-related search terms from March-May 2020 suggests a transient but substantial decrease in public focus on cardiovascular-related healthcare engagement. Future research is needed to understand if these mixed signals will persist into 2021 and how they potentially translate into real-world CVD-related event rates.

Keywords: ACS, Acute coronary syndrome; CVD, Cardiovascular disease; Cardiovascular disease; Google trends; Infodemiology; Primary prevention; RSV, Relative search volume.

Fig. 1

US interest in search terms related to cardiovascular lifestyle and behavior, Google Trends RSV for the time periods (A) October 1, 2019 to October 1, 2020 presented as weekly data and (B) October 1, 2016 to October 1, 2020 averaged tri-weekly for common cardiovascular-related lifestyle and behavior terms, namely “Exercise” (purple), “Fruits & Vegetables” (dark blue), “Tobacco Products” (green), and “Cigarettes” (dark red). Lines with dotted markers indicate data from Google Shopping Insights; all other depicted lines represent data from Google Trends. Shaded area: World Health Organization (WHO) on March 11, 2020 has declared the COVID-19 outbreak a global pandemic. Dashed line in lower panel implicates start of upper panel to visualize transient trends amidst COVID-19 pandemic versus long-term seasonal trends. (Search query: October 5, 2020).

Fig. 2

US interest in exercise-related search terms; Google Trends RSV for the time periods (A) October 1, 2019 to October 1, 2020 presented as weekly data and (B) October 1, 2016 to October 1, 2020 averaged tri-weekly for common exercise-related search terms, namely “High-intensity interval training” (blue), “Cycling” (purple), “Aerobic exercise” (yellow), and “Gardening” (dark green). All depicted lines represent data from Google Trends. Shaded area: World Health Organization (WHO) on March 11, 2020 has declared the COVID-19 outbreak a global pandemic. Dashed line in lower panel implicates start of upper panel to visualize transient trends amidst COVID-19 pandemic versus long-term seasonal trends. (Search query: October 5, 2020).

Fig. 3

US interest in search terms related to diagnostic and therapeutic options of CVD comorbidities. Google Trends RSV for the time periods (A) October 1, 2019 to October 1, 2020 presented as weekly data and (B) October 1, 2016 to October 1, 2020 averaged tri-weekly for common CVD-related diagnostic and therapeutic options, namely “Statin” (purple), “Metformin” (green), “Lipid profile” (dark red), “Low-density lipoprotein” (dark blue), and “Hemoglobin A1C” (yellow). All depicted lines represent data from Google Trends. Shaded area: World Health Organization (WHO) on March 11, 2020 has declared the COVID-19 outbreak a global pandemic. Dashed line in lower panel implicates start of upper panel to visualize transient trends amidst COVID-19 pandemic versus long-term seasonal trends. (Search query: October 5, 2020).