OBJECTIVES: Examine frequency and costs of disability among employed individuals with COPD. METHODS: Retrospective analysis of disability and medical claims data for employees of nine national self-insured companies. Active employees 40-63 years old with diagnosis of COPD (ICD-9-CM: 491.xx,492.x,496) between January 1, 2001 - December 31, 2003 were identified. Index date was later of: 1) first COPD diagnosis, or 2) first date of eligibility for short-term disability (STD), long-term disability (LTD), and health benefits. Employees with cystic fibrosis, lung cancer, tuberculosis, or pregnancy, and those continuously eligible for <90 days following index date, were excluded. Using propensity score matching, controls were matched 2:1 to COPD subjects on age, gender, geographic region, employer, length of employment, and salary range. Subjects were followed until the earliest of non-active employee status, disenrollment from any benefit, 365 days of follow-up, or March 31, 2004. Likelihood of disability was compared between COPD subjects and controls using logistic regression, adjusting for length of follow-up and specific comorbidities. Indirect costs of disability, measured as disability days multiplied by subjects' daily wage, were compared among subjects with a disability claim using GLM with a gamma distribution and log link, adjusting by the aforementioned covariates. RESULTS: Mean length of follow-up for COPD subjects (n=1349) and controls (n=2696) was 220 and 233 days. Mean age was 52 years, and cohorts approximately 50% male. All comorbidities were more common in the COPD cohort. A greater proportion of COPD subjects used STD (21.8% vs. 7.0%), LTD (2.4% vs. 0.4%), or any disability benefit (22.8% vs. 7.3%). Odds ratios for likelihood of disability for COPD subjects were: STD, 2.11 (95% CI: 1.64-2.71); LTD, 4.21 (1.93-9.16); any disability, 2.15 (1.68-2.75). CONCLUSIONS: Among those with disability (307 COPD patients, 197 controls), indirect costs were higher among COPD subjects ($8559) than controls ($5443); this approached significance (p=0.07).