Background: little is known about associations between occupational prestige, that is, the symbolic evaluation and socialpositioning of occupations, and sickness absence (SA) or disability pension (DP). We explored whether occupational prestigewas associated with future SA or DP among women and men. Methods: A Swedish 4-year prospective cohort study of allthose in paid work and aged 25–59 in 2010 (N = 2,605,227; 47% women), using linked microdata from three nationwideregisters and Standard International Occupational Prestige Scale values, categorised as ‘very low’, ‘low’, ‘medium’, ‘high’,or ‘very high’. Odds ratios (Ors), 95% confidence intervals (CIs), crude and adjusted for several sociodemographic factors,were calculated for three outcomes: at least one SA spell (>14 days), >90 SA days, or DP occurrence, during follow-up(2011–2013). Results: The mean number of SA days in 2010 varied by occupational prestige group, for example, ‘very high’:3.0, ‘very low’: 6.5. Compared to those in occupations with ‘very high’ prestige, all other groups had higher adjusted Orsfor all three outcomes. Among men, those with ‘very low’ occupational prestige had the highest Or for at least one SA spell:Or 1.51 (95% CI 1.47–1.56); among women, the ‘medium’ group had the highest Or: 1.30 (1.27–1.32). The results weresimilar for SA >90 days. Or for DP among women with ‘very low’ occupational prestige was 2.01 (1.84–2.19), and 3.55(3.15–4.01) for men. Conclusions: Working in lower occupational prestige occupations was generally associatedwith higher odds of future SA/DP than working in higher prestige occupations; these associations were strongerfor men than for women.