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Seasonal manifestations of sickle cell disease activity

Nature Medicine volume 25, pages 536–537 (2019)Cite this article

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To the Editor — Sickle cell disease (SCD) is a β-globin disorder characterized by recurrent vaso-occlusive episodes, driven by hemoglobin S polymerization and neutrophil recruitment, and influenced by environmental factors1,2. Whether cold weather is associated with the acute pain episodes that accompany SCD has been controversial, likely because of the small number of patients in each report and methodology that relied on analyses of hospital admissions2,3,4,5,6,7,8. In the digital age, the first line of defense for most patients is a search engine on their smartphones or computers. A search engine gathers data from millions of users around the world and thus may represent a powerful tool for estimation of disease activity. For example, Google web search queries have been used to detect influenza epidemics9. Here, we use the Google Trends tool (https://trends.google.com/) to investigate whether there is a seasonal change in manifestations of SCD.

To further confirm the periodicity of disease manifestations, we evaluated the profiles of well-established seasonal diseases. For example, the trend for ‘bronchiolitis’ showed a strong periodicity with peaks during the winter months in the United States, whereas the trend profile for this term was inverted in Brazil (Fig. 1d,e,h,i). Similar results were obtained with ‘influenza,’ although in this case, the profiles were punctuated by high-amplitude peaks corresponding to well-documented outbreaks (Extended Data Fig. 3e–g).

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Fig. 1: Google Trends reveals seasonal interest in SCD.

Data availability

All data supporting this article are available from the corresponding author upon request.

Code availability

All custom codes used in this article are available from the corresponding author upon request.

References

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Acknowledgements

This work was supported by R01 grants from the National Institutes of Health (NIH) (HL069438, DK056638, DK116312, DK112976) to P.S.F.

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Authors and Affiliations

  1. Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research and Departments of Medicine and of Cell Biology, Albert Einstein College of Medicine, Bronx, NY, USA

    Chunliang Xu & Paul S. Frenette

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  1. Chunliang Xu
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Correspondence to Paul S. Frenette.

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Competing interests

P.S.F. has served as consultant for Pfizer, received research funding from Ironwood Pharmaceuticals and owns stock options of Cygnal Therapeutics.

Extended data

Extended Data Fig. 1 Trends for sickle cell disease in different states of the United States.

a–d, Trends of search indexes from January 2004 to August 2018 for ‘sickle cell disease’ (under disorder) in Indiana (P < 0.001) (a), New York (P < 0.001) (b), Texas (P < 0.001) (c) and Georgia (P < 0.01) (d). Search index was plotted in the red tracings. The vertical dotted blue lines mark the beginning of each year. Cosinor analysis was performed using R Packages. The black lines correspond to the fitted cosine curves.

Extended Data Fig. 2 Trends for sickle cell disease in different countries.

a–g, Trends of search indexes from January 2004 to August 2018 for ‘sickle cell disease’ (under disorder) in the United Kingdom (P < 0.0001) (a), Canada (P < 0.0001) (b), Chile (P < 0.0001) (c), Argentina (P < 0.01) (d), Australia (P < 0.01) (e), and Nigeria (P = 0.58) (f). Search index was plotted in the red tracings. The vertical dotted blue lines mark the beginning of each year. Cosinor analysis was performed using R Packages. The black lines correspond to the fitted cosine curves.

Extended Data Fig. 3 Trends for prostate cancer, myeloma, dementia, cirrhosis and influenza.

Trends of search indexes from January 2004 to August 2018 for ‘prostate cancer’ (under disease) in the United States (P = 0.6) (a), ‘myeloma’ (under term) in the United States (P = 0.5) (b), ‘dementia’ (under disease) in the United States (P = 0.99) (c), ‘cirrhosis’ (under disease) in the United States (P = 0.34) (d), ‘influenza’ (under disease) in the United States (P < 0.00001) (e), ‘influenza’ (under disease) in Brazil (P < 0.01) (f), and ‘influenza’ (under disease) in Australia (P < 0.00001) (g). Search index was plotted in the red tracings. Note the high amplitude peaks in influenza tracings correspond to pandemic episodes (e.g., H1N1 swine flu pandemic in spring 2009). The vertical dotted blue lines mark the beginning of each year. Cosinor analysis was performed using R Packages. The black lines correspond to the fitted cosine curves.

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Xu, C., Frenette, P.S. Seasonal manifestations of sickle cell disease activity. Nat Med 25, 536–537 (2019). https://doi.org/10.1038/s41591-019-0409-3

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