Background <p>Presenteeism, the act of working while ill, is increasingly recognized as a key occupational health challenge with significant consequences for productivity and future work incapacity. Yet, longitudinal evidence on its temporal interplay with absenteeism remains scarce. We aimed to examine the lagged and bidirectional relationships between presenteeism and absenteeism using nationally representative multi-wave panel data from Korean wage workers.</p> Methods <p>We analyzed four waves (2019–2022) of longitudinal survey data from 4,180 baseline participants, with follow-up rates of 76.8% (wave 2), 66.6% (wave 3), and 58.4% (wave 4). Mixed-effects logistic regression models estimated the effect of prior-wave presenteeism on subsequent absenteeism, adjusting for covariates measured at the preceding wave. Bidirectional cross-lagged panel models were used to assess reciprocal relationships over time.</p> Results <p>Presenteeism prevalence ranged 12.7–25.0%, exceeding absenteeism prevalence (8.6–12.3%) across all waves. In mixed-effects models, prior-wave presenteeism predicted 30% higher odds of absenteeism at the next wave (odds ratio = 1.30, 95% confidence interval: 1.08–1.56, <i>p</i> = .005). The bidirectional model showed significant cross-lagged effects from presenteeism to absenteeism in two of three intervals, but absenteeism did not predict future presenteeism. Strong autoregressive effects were observed for presenteeism and absenteeism.</p> Conclusions <p>Presenteeism is consistently associated with subsequent absenteeism among Korean workers and may serve as a useful risk marker for future absence; however, results should be interpreted as longitudinal associations as within-person effects were attenuated in a random-intercept sensitivity analysis. These findings highlight the potential importance of coordinated policy and organizational approaches—such as statutory paid sick leave, supportive sick leave cultures, and proactive health monitoring—in addressing problematic presenteeism.</p>