Why do women live longer than men, but spend more time in poor health? A decomposition analysis of the gender gap in unhealthy life years across Europe

This study tests the "longevity hypothesis," which posits that women's greater number of years spent in poor health is primarily a direct consequence of their longer survival. We analyse gender differences in unhealthy life years (ULY) at age 50 across 22 European countries in 2015-2017. ULY was estimated using three approaches-the Sullivan method, the cross-sectional average length of healthy life, and multistate life tables-applied to four health indicators of varying severity: chronic diseases, functional limitations, self-rated health, and disability. Data were drawn from the Human Mortality Database and the Survey of Health, Ageing and Retirement in Europe. We decomposed the gender gap in ULY into a "mortality effect" (ME), reflecting differences in life years lived, and a "health effect" (HE), reflecting differences in morbidity prevalence. Women at age 50 lived more unhealthy years than men across almost all health indicators and countries. In most cases, more than half of the gender gap in ULY was attributable to the ME, indicating that women's longer survival primarily explains their greater number of years spent in poor health. The HE showed greater variation across indicators and countries. Results were most consistent for chronic diseases and self-rated health, while functional limitations and disability yielded smaller and less consistent differences. Findings support the longevity hypothesis: women's higher life expectancy is the main driver of their longer lifetime spent in poor health. The variation across health dimensions highlights the importance of distinguishing between them when studying gender inequalities in health.