Introduction:
Self-rated health (SRH) is a common measure for examining gender differences in health. However, it is unclear if men and women assess similar health factors in their ratings, particularly outside the US. This study expands on previous research in Germany, Italy, and Sweden–countries with varying gender norms.

Methods:
We analyze how chronic conditions, mental health, physical functioning, and health behaviors affect SRH ratings among 50,912 respondents aged 50–79, using panel data from SHARE and HRS and random effects multinomial logistic models.

Results:
Our findings indicate that women in the US and Italy are less likely than men to report very good health, while no gender differences were found in Germany and Sweden. Additionally, women in all countries except Germany were more likely to report poor health. Despite variations in gender gaps in SRH across the four countries, the underlying meaning of SRH did not differ between men and women, as health indicators contributed comparably to their ratings. The only exception was mental health, where women reported better SRH than men despite similar levels of depression.

Conclusion:
Overall, our results suggest that SRH is a comparable measure for assessing gender differences in health across these countries.