Agriculture can be seen as an occupational sector in which the workers are exposed to many health risks that may result in sick leave and working disability. The aim of this study was to gain insight into the problem of sick leave among Dutch farmers. A risk analysis of sick leave was performed in the agricultural branches to address the occurrence and duration of sick leave, as well as the main diagnoses of sick leave and the associations between sick leave and the farm- and work-related, psychosocial and personal risk factors. Data were collected from a database of a major Dutch insurance company with information on sick leave claims, by a questionnaire among farmers with or without a sick leave claim in the period 1998-2001 and from experts in the field of occupational health in agriculture. The results show that the risk of sick leave in the period 1994-1998 was constant over time, it varied between the agricultural branches, being the lowest in arable farming and the highest in mushroom farming. The highest incidence and the slowest recoverywasseen in the oldest age category. Overall, the main causes of sick leave were musculoskeletal disorders and injuries, of which 74% was work-related. For sick leave due to work-related injuries, farmers working in dairy farming or pig husbandry, older farmers and smokers were at increased risk. The dominant risk factors for sick leave due to back, neck, shoulder or upper extremity disorders were personal variables: increased age, smoking and former complaints. Farm characteristics and 'high work pace and workload' were also contributing. A strong association was found with farmers' exposure to combined physical load (multipleexposureto physical risk factors). On the basis of this study, reduction of sick leave among Dutch farmers should first of all be focused on the incidence of musculoskeletal disorders and work-related injuries.