Background: The dissemination of high quality, timely evidence is a priority for The Cochrane Collaboration. By monitoring usage, exploring user activity, and identifying trends we can build on our understanding of how people use The Cochrane Library, where they come from, and which reviews they access. We can use these data to help us identify ways of increasing access to and usage of The Cochrane Library worldwide. Methods: For the period of 1st January 2008 to 31st December 2008, the number of unique visits to www.thecochranelibrary.com, number of visits by country, and most accessed Cochrane reviews on Wiley InterScience were taken from the Wiley InterScience Data Warehouse, an analysis tool that stores and tracks usage data. Another set of usage data was obtained from all other licensed providers of The Cochrane Library, showing the number of abstracts and full text articles that were accessed during 2008 from Wiley InterScience, EBSCO, OVID, La Biblioteca Cochrane, BIREME and www.cochrane.org. Results: Data taken from all providers of The Cochrane Library show that during 2008: A search of The Cochrane Library took place every 2 seconds; A Cochrane abstract was viewed every 3 seconds; A full text article was downloaded every 4 seconds. Conclusions: In summary, usage of The Cochrane Library in 2008 has increased considerably in comparison to 2007. Over half the world’s population now have access to The Cochrane Library via one-click access (no login required), and it is clear that worldwide usage of The Cochrane Library is increasing as a consequence.