Google searches for alcohol and association with alcohol-related outpatient encounters before and during the COVID-19 pandemic

Google search trends at a population level have been shown to correlate with epidemiologic phenomena, including those related to mental health and substance use disorders. This retrospective cohort study examines associations between the rate of alcohol use-related outpatient primary care clinic visits in Kaiser Permanente Northern California and aggregate Google Search trends for the search term topic "alcoholic beverage" within the same geographic area, between 01/01/2017 and 12/31/2021. A total of 45,819,668 outpatient encounters were identified during this time frame, with 211,307 of these encounters including an alcohol-related diagnosis. A time-lagged correlation analysis (0-13 weeks) revealed a weak but consistent positive association at 2-6 weeks (max Pearson's r = 0.18, Spearman's p = 0.13). The study also used an autoregressive integrated moving average (ARIMA) model to forecast expected Google search rates from pre-pandemic data (2017-2019) and compare those to observed rates during the pandemic (2020-2021); observed search volumes exceeded forecasted values in late March 2020 (p < 0.001), coinciding with COVID-19 shelter-in-place orders, and again around January of each year. This study represents a first step toward understanding the utility of Google search trends in augmented public health surveillance of alcohol-related healthcare needs and suggests that web-search data may reflect short-term shifts in alcohol-related behaviors, especially during disruptive events such as the COVID-19 shelter-in-place period.