Rationale COPD is a highly prevalent disease and a leading cause of morbidity and mortality. This study investigates COPD-excess work absenteeism and healthcare utilization based on data from the German COSYCONET (“German COPD and Systemic Consequences - Comorbidities Network”) COPD cohort. Methods Self-reported data on work absence and healthcare utilization from 2,288 COPD patients in grade 1 to 4 (GOLD definition, % predicted values according to ECSC) from the COSYCONET cohort was compared with 1,629 controls without COPD from two pooled population-based KORA (“Cooperative Health Research in the Augsburg Region”) studies. Multiple generalized linear models were used to analyze the association of COPD grades with healthcare utilization and work absence while considering differences in sex, age, education, smoking status, BMI and 5 comorbid conditions (stroke, cancer, diabetes, myocardial infarction, and arthritis). Results The total study sample comprised 3,917 participants, mean age 64.3 years, 55.4% males. COPD grade 1-4 significantly increased both the number of physician visits in the last 3 months (all p < 0.0001) and the number of hospital days in the last 12 months (all p <0.005). The adjusted number of physician visits was 2.9 in controls without COPD and 6.2/6.3/6.6/6.3 in COPD grades 1-4. Regarding hospital days, the adjusted number of days increased with COPD disease grade and was 2.5/3.8/7.1/11.3 in grade 1-4 and 1.3 days in controls. Regarding comorbid conditions, an additional diagnosis of cancer or stroke had the largest effect on utilization, but the effects were smaller than the effects of COPD grade 3 or 4. Of those under the age of 65 years (n=2,147), a regular full- or part-time employment was reported by 84% of controls and by 52%/46%/34%/17% of participants in COPD grade 1-4. After adjustment for covariates, the number of sick days in working participants was increased by factor 4.4 in COPD grade 1-3 and by factor 6.8 in grade 4 compared with controls. Resulting adjusted sick days in the last 12 months were 5.9 in controls and 27.4/26.5/28.3/39.0 in GOLD grade 1-4. Cancer or arthritis as an additional condition had increasing effects on sick days, but the effects were smaller than the effect of COPD. Conclusions High healthcare utilization and work absence is observed in COPD patients even in early stages of disease. From a societal perspective, interventions focusing on improving the ability to work in younger COPD patients would be beneficial in order to reduce the indirect costs of COPD
