OBJECTIVES: To compare health-related quality-of-life (HRQoL) and resource use in patients with metabolic syndrome across three geographies. METHODS: Data used from the 2008 National Health and Wellness Survey (NHWS), an annual internet survey of adults in the US, EU (Germany, Spain, Italy, UK, and France), and Japan (JPN).  Metabolic syndrome was defined as having at least three of: diabetes, BMI >=30, high cholesterol, or hypertension. Resource use included emergency room (ER) visits, hospitalizations, and visits to traditional healthcare providers. Linear regression was used to determine the effects of geography on the physical component summary score (PCS) and mental component summary score (MCS) of the SF-12, and Poisson regression for resource use, controlling for age, gender and total number of comorbidities. RESULTS: Of the 11,131 patients with metabolic syndrome 2,503, 185 and 8,443 were from EU, JPN, and US, respectively. All prevalence numbers were significantly different from one another (p<0.05).  Mean MCS scores were 45.86, 45.84, and 47.39 for EU, JPN and US, respectively, with a significant difference between EU and US (p<0.05). The PCS score for JPN (44.86) was significantly higher than both US (38.76) and EU (38.41) PCS scores (p<0.05).  After controlling for confounders, JPN MCS scores were 2.87 points lower than the US (p<0.05), while EU scores were 2.09 points lower (p<0.05). JPN PCS scores were 4.92 points higher (p<0.05), and EU scores were 1.22 points lower than the US (p<0.05). The regression results for resource use showed JPN with fewer ER visits than US, and both JPN and EU with more hospitalizations, and more provider visits (p<0.05). CONCLUSIONS: There are significant differences in prevalence and possibly awareness of metabolic syndrome across the three regions. Also, significant differences were seen in both HRQoL and resource use. Further research is needed to describe the burden of metabolic syndrome globally.