Global information-seeking behavior of air pollution and cardiovascular disease: insights from google trends analysis

Air pollution (AP) contributes to over 4.2 million premature deaths annually, with approximately 20% linked to cardiovascular disease (CVD)-related deaths. Despite robust scientific evidence, information-seeking behavior remains poorly characterized. This study applies an infodemiological approach to assess global information-seeking behavior related to AP and its cardiovascular implications.

A retrospective analysis was conducted using Google Trends data from June 2020 to June 2025. Five AP-related search terms (e.g., "air pollution," "PM₂.₅," "air quality index," "environmental pollution," and "mask") and five CVD-related search terms (e.g., "cardiovascular disease", "heart disease," "heart attack," "chest pain," and "high blood pressure") were analyzed globally. Pearson correlation coefficients, partial correlation analysis controlling for pandemic-related confounding, and time-series approaches including ARIMAX modeling and Granger causality testing were applied to assess temporal and correlational patterns in information-seeking behavior.

Global information-seeking behavior showed marked variability across AP and CVD search terms. AP showed moderate positive correlations with "CVD", "heart disease", and "high blood pressure" (r = 0.275;0.295;0.386, p < 0.01). "Environmental pollution" showed a moderate correlation with "heart disease" (r = 0.417, p < 0.01) and "blood pressure" (r = 0.315, p < 0.01). Technical AP indicators showed weak or negative zero-order associations with most CVD terms; however, sensitivity analysis controlling for pandemic-related confounding revealed complete directional reversal for PM₂.₅, with partial correlations becoming significantly positive, indicating that original negative associations were pandemic-driven artefacts. Search volumes were highest for Chest Pain and High Blood Pressure, with low global engagement for PM₂.₅ and AQI. Twenty-seven countries, including Pakistan, India, and Australia, demonstrated concurrent AP and CVD information-seeking behavior.

This analysis indicates moderate information-seeking behavior in the association between AP and CVD, with geographic variation. Findings highlight the need for targeted public health communication strategies that translate AP risk into accessible cardiovascular health messages.