Objectives: The aim of this study was to examine the relation between sickness presenteeism and different types of future sickness absence in 2,983 Belgian middle-aged workers. Methods: Data were collected from 1,372 male and 1,611 female workers. Presenteeism was assessed by a single question, evaluating the frequency of occasions of going at work, despite illness, during the preceding year. Prospective, registered sickness absence data were collected during 12 months of follow-up. Multivariate logistic regression models were used to investigate the relationship between presenteeism and short/long spells of absenteeism and high sickness absence frequency. Results: High rates (>5 times) of presenteeism at baseline were significantly and independently associated with both long spells of sickness absence (at least 15 consecutive sick leave days) (men, OR=2.73, 95% CI=1.24−6.03; women, OR=2.40, 95%CI=1.31−4.40) and short spells of sickness absence (sick leave between 1 and 3 days) (men, OR=2.38, 95%CI=1.25−4.51; women, OR=1.90, 95%CI=1.17−3.11) in both genders during one year follow-up. Moderate rates (2−5 times) of presenteeism were significantly associated with long spells of sickness absence only in the male group (OR=1.90, 95%CI= 1.21−2.97). With regard to high sickness frequency (at least 3 sick leave episodes), a significant and positive association with high rates of presenteeism was demonstrated only in the female workers (OR=2.38, 95%CI=1.40−4.04). Conclusions: These results suggest that presenteeism was related to different types of future sickness absence.(J Occup Health 2013; 55: 132−141)