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.
Level 3 - non-randomized controlled study
Demographic decomposition analysis using survey and mortality database cohorts (by design analogy, not clinical CEBM)
PubMed 41524888 · doi:10.1007/s10654-025-01346-2
What was done
The authors tested the "longevity hypothesis" to evaluate whether women's excess years lived in poor health are primarily driven by longer survival. Using data from the Human Mortality Database and the Survey of Health, Ageing and Retirement in Europe (SHARE) for 2015–2017 across 22 European countries, they analyzed gender differences in unhealthy life years (ULY) at age 50. ULY was estimated using the Sullivan method, the cross-sectional average length of healthy life, and multistate life tables across four health indicators: chronic diseases, functional limitations, self-rated health, and disability. The gender gap was decomposed into a mortality effect (survival differences) and a health effect (morbidity prevalence differences).
What was found
Women at age 50 lived more unhealthy years than men across almost all examined health indicators and countries. In most cases, more than half of the gender gap in ULY was attributable to the mortality effect. The health effect varied substantially by indicator and country, with the most consistent gender differences observed for chronic diseases and self-rated health, while functional limitations and disability showed smaller and less consistent differences. Exact numerical estimates were not reported in the abstract.
Why it matters
This study provides multi-country demographic evidence that the female disadvantage in unhealthy life years is largely driven by longer survival rather than worse baseline health alone, emphasizing the need to distinguish between different dimensions of morbidity.
Limits
The abstract does not report sample sizes, specific numerical values, or confidence intervals. Findings rely on self-reported health and survey measures, which may carry reporting biases between genders, and conclusions vary depending on the specific health indicator evaluated.
Cited by
- supports The sex difference between men and women in healthspan is smaller than the sex difference in lifespan.