Gender gaps in healthy life expectancy are frequently used as indicators of health inequality between women and men. However, total gaps can be misleading—masking critical disparities such as women living longer yet spending more years with disability or illness, or men experiencing premature mortality. We therefore critically evaluate whether these gaps accurately capture gender-based health.

We estimate gender gaps in disability- and chronic disease-free life expectancy using the Sullivan method and decompose those gaps via the continuous-change approach to distinguish mortality from morbidity contributions. Data are drawn from the harmonised Gateway to Global Aging Data and the UN life tables from the 2022 Revision of World Population Prospects for all countries, except England, where the life tables are from the UK Office for National Statistics.

The analysis is performed on 24 countries and regions, including the USA, England, South Korea, China, India, Mexico and 19 European Union countries for the years 2014–2015 and 2017–2019 (N=201 723).

The main outcomes are gender gaps in disability- and chronic disease-free life expectancy and the contribution of mortality and health in explaining the gender gap.

Gender gaps in disability-free life expectancy ranged from –0.37 years (Portugal) to almost 5 years (South Korea), with most European countries showing female advantages of 3.0–3.5 years, while minimal gaps were observed in China, Mexico and India (0.4–0.9 years). Decomposition revealed striking inconsistencies between total gaps and underlying components—South Korea’s 4.9-year gap reflected a survival advantage outweighing disability disadvantage by 13-fold, while Portugal’s –0.37-year gap masked opposing contributions (mortality: +2.3; disability: –2.7). Chronic disease-free life expectancy showed female disadvantage in most countries, especially Portugal (–2.3), Korea (–1.6) and Mexico (–1.9).

Using gender gaps in healthy life expectancy as a metric for gender inequality in health is misleading. Countries with very different levels of development, healthcare systems and gender roles can have similar gender gaps, but substantial differences in the levels of mortality and health. Because these gaps mask important underlying differences in health and mortality between women and men, caution is warranted when using them.