Why do women live longer than men? What biology, smoking and the Dutch figures explain

In this article you will find the answer to the question ‘why do women live longer than men’ for the Netherlands: which part of the difference has a biological cause, which part has a cause in habits such as smoking, and why the extra years are not all healthy years. That matters, because people often see the difference as fate, while the studies show that a large part of it changes with how people live. BioProfile’s lifestyle scan gives you a picture of your own daily habits, so you can see where you stand today. It is self-insight, and it can help you make better choices in your diet and lifestyle. The scan is not a diagnosis. The scan does not point to a cause and does not assess your health. Only a doctor can do that.

How much longer women live in the Netherlands

In 2024, life expectancy at birth in the Netherlands was 83.28 years for women and 80.53 years for men, a difference of 2.75 years. In 2019 the difference was 3.10 years, and in 2023 it was 3.02 years. In 2024, life expectancy for men was slightly higher than before the coronavirus pandemic. For women, it was still slightly lower.⁠¹ Life expectancy is expected to rise for everyone: from 81.6 years in 2022 to 86.5 years in 2050. In the RIVM trend scenario, men live 3 to 3.5 years less than women, both in 2022 and in 2050.⁠⁵

In plain words: based on the death rates measured in 2024, a Dutch girl can expect to live a few years longer than a boy. The difference has become smaller in recent years, but the forecast still assumes it will stay at about three years.

Why women live longer than men: the biology

Humans are the only known species in which one sex lives longer everywhere, and that sex is women.⁠⁶ History gives a strong hint that this is partly biological. Researchers studied seven populations that went through famines, epidemics and slavery. At almost every age, women died less often than men. In all but one of the enslaved populations, women also lived longer on average. Babies made up most of the gap: newborn girls survived the extreme conditions better than newborn boys. At that age, behaviour and social roles barely differ.⁠² The authors conclude that the female survival advantage has biological roots, and that its size depends on the environment and on social factors.⁠²

Put simply: even before smoking, work or risk-taking play a part, girls start out with a small head start in survival.

What that biology is exactly remains unclear. One review names possible explanations: hormones, the unequal way sex chromosomes and mitochondria are passed on, immune responses and resistance to oxidative damage. The authors call the evidence for these explanations weak so far.⁠⁶

So the head start is real, but its exact cause cannot yet be pinned down.

Why men live shorter lives: smoking and causes of death

Biology sets a starting point, and habits largely decide how big the gap becomes. Across 31 European countries together, deaths linked to smoking accounted for about 3 of the 7 years that women outlived men in 2014. In 1995, smoking explained 5.2 of the 9.0 years. Since then the gap has narrowed, along with the share caused by smoking. That recent fall is almost entirely explained by changes over time in how many men and women smoked, and the gap is expected to narrow further.⁠³

Put simply: in Europe in 2014, almost half of the difference between women and men was down to smoking.

In the Netherlands, men still smoke more often. In 2022/2023, 21 per cent of men aged 12 and over smoked at least occasionally, compared with 15 per cent of women. Men also kept to the alcohol guideline less often: 37 per cent did, compared with 54 per cent of women.⁠⁴

Which causes of death make up the gap? A comparison of ten countries found that cancer, heart disease and external causes such as accidents contributed most to the difference.⁠⁷ In Australia, according to the figures for 2016-2019, women aged 25 can expect to live 3.79 years longer than men of the same age. Cardiovascular disease accounted for almost a third of that gap, cancers other than lung cancer for about a quarter, and external causes such as accidents and suicide for about a fifth. Education played a part too. Among people with a university education, the gap was 2.28 years. Among people with less than secondary education, it was 4.67 years.⁠⁸

What this means for you: the gap comes mostly from heart disease, cancer and accidents, and it is smaller among people with more education. So much of it depends on how people live, and less of it is fixed at birth.

Longer, but not healthier

Women live longer, but they do not have more healthy years. According to the figures for 2023, Dutch women can expect 62.4 years in self-rated good health, compared with 64.1 years for men. Years without limitations came to 55.5 for women and 59.4 for men. Women live about 3 years longer, but spend roughly 7 more years with limitations.⁠⁴ The review article mentioned above calls this a paradox: women live longer, but have more health complaints, especially at an older age.⁠⁶ You can see part of this in the causes of death. In the Netherlands, the share of deaths from mental disorders and diseases of the nervous system, including dementia and Alzheimer’s disease, is almost twice as large in women as in men.⁠¹ Of the 4.9 extra years of life expectancy the RIVM foresees for 2050, about 1.2 years are expected to be lived with some limitation.⁠⁵

Put simply: many of the extra years women get are years with health complaints. How long you live and how long you live well are two separate questions. How your body’s age can differ from the age in your passport is explained in biological age versus calendar age, and what changes in the body over the years is covered in healthy ageing: what changes over the years.

When to ask for help

Every year in the Netherlands, 6 in 1,000 men and 3 in 1,000 women have a heart attack. Thuisarts lists these signs: a pressing feeling or pain in the chest, together with fear or a sense that something serious is happening, harder breathing, sweating or clammy skin, and nausea. People over 65 more often have no pressure or pain in the chest. Instead, their breathing is difficult and fast, and they have extreme tiredness, dizziness or a restless feeling. Have you had a heart attack before? Then call 112 if you feel restless, sick and sweaty, or if the pressure on your chest does not go away after 3 tablets or puffs under the tongue.⁠⁹

In plain words: pressure on the chest with sweating or nausea can be a sign of a heart attack. In older people, the signs can be less clear.

What the lifestyle scan shows

The lifestyle scan asks about your daily habits and gives you a picture of where you stand today. That is a baseline. Repeat the scan after a while and you have two results to compare, which tells you more than a feeling can. The scan cannot tell you how long you will live, and it does not point to a cause for a complaint. The scan is not a diagnosis.

In summary

Women in the Netherlands live a few years longer than men.⁠¹ Part of that lead is biological and can even be seen in newborns during famines and epidemics.⁠² A large part comes from habits, with smoking at the top,⁠³ and from heart disease, cancer and accidents.⁠⁷ Not all the extra years women get are healthy years.⁠⁴ It helps to know the signs of a heart attack,⁠⁹ and the lifestyle scan shows where your own habits stand today.