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We analyse gender differences in unhealthy life years (ULY) at age 50 across 22 European countries in 2015\u20132017. ULY was estimated using three approaches\u2014the Sullivan method, the cross-sectional average length of healthy life, and multistate life tables\u2014applied 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 \u201cmortality effect\u201d (ME), reflecting differences in life years lived, and a \u201chealth effect\u201d (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\u2019s 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\u2019s 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.<\/jats:p>","DOI":"10.1007\/s10654-025-01346-2","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T09:02:23Z","timestamp":1768208543000},"page":"329-336","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Why do women live longer than men, but spend more time in poor health? 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