Declining interest in tattoos in the Balkans: a Google Trends analysis

Dear Editor, Tattooing is a popular decorative procedure worldwide1,2. Its prevalence in adults ranges from 20 to 30%1,3. However, Google Trends (GT) infodemiological data indicate that interest in tattoos began declining before the COVID-19 pandemic4. As trends may vary across regions, we aimed to determine whether a similar pattern occurred in Eastern Europe and the Balkans. We used the same method as published elsewhere for previous tattoo health-related research using GT2,4,5. GT is a useful website that provides data on the relative search volume (RSV) of queries and topics over time and across geographical areas (worldwide, country, city). It allows seasonal and long-term assessment of trends in public interest. We analyzed the data generated through GT, for the mean RSV on the topic "tattoo" for each Balkan country (Albania, Bulgaria, Greece, North Macedonia, and the nations of the former Yugoslavia: Bosnia and Herzegovina, Serbia, Croatia, Montenegro, and Kosovo) from January 1, 2004, to December 27, 2025. Results are displayed as a set of time series. The values are not the actual search counts but percentages relative to the total searches across the specified geography and time. The resulting numbers are then scaled from 0 to 100 based on the proportion to all searches on all topics. All data used in this study are publicly available, anonymous, and cannot be traced back to identifiable individuals. Every country displayed the similar seasonal search patterns as observed elsewhere2 with peaks during summer and dips during December (data not shown). Between 2004 and 2025, interest in tattoos has first increased gradually before reaching a peak around 2011-2019, depending on the country, followed then by a constant decrease (table 1). The phenomenon is notable in every Balkan country (Fig 1). Only Kosovo shows a mean increase in search. The prevalence of tattooing in the Balkan peninsula is globally unknown. Available studies are usually limited by strong bias of selection. A small Croatian study found that about 15% of surveyed patients reported having at least one tattoo6. About 19 % of adult Bulgarians reported having a tattoo in 20227. In Greece, a study among young Athenians aged 19-25 years-old, the prevalence was elevated however the study was most likely biased due to the recruitment procedure8. It is rather likely that the prevalence at least in urban areas in the Balkan mirrors results observed in Western or Northern Europe. However, it is interesting to discern that the same trend regarding a decrease in interest in tattoos can be observed both in Western and Eastern Europe. Kosovo appears as an outlier compared to its neighbors. The increase may be explained by the rapid expansion of the use of internet in the country9. Besides, a careful analysis of the overall trends in Kosovo shows rather a stabilization now (data not shown). As observed previously, the decrease began before COVID-194, indicating that the pandemic cannot be held responsible. This trend is corroborated by tattoo artists and industry observers who report a slowdown in demand, with appointment books no longer filling as quickly and income diversification becoming necessary. Rising inflation and living costs may reduce tattoos' priority for consumers. Additionally, established artists face increasing competition in an unregulated sector characterized by oversupply, low visibility for those not active on social media, and growth of low-cost alternatives (e.g., home-made tattoos and online equipment purchases). Media coverage of the potential carcinogenicity of tattoo inks, often sensationalized despite robust evidence10, may have further contributed. Study limitations include reliance on Google Trends, which is not a true epidemiological tool and only captures internet users, limiting population representativeness9. Acknowledging the limits of our study, the current loss of interest in tattoos seems widespread and across Europe.