Background <p>Diving involves unique physiological stressors and environmental exposures that may affect health outcomes. Long-term survival among divers results from a complex interaction between potentially harmful exposures related to the hyperbaric environment and oxidative stress, diving-related accidents, as well as protective factors such as physical fitness, psychological resilience, and socioeconomic status. The aim of this study was to evaluate long-term survival in a cohort of Czech divers compared with the general population.</p> Methods <p>Data from 1,076 divers registered in the DIVE-PFO Registry (2005–2024) were linked with the National Health Information System to determine mortality and causes of death. Observed survival was estimated using the Kaplan–Meier method; expected survival was based on national life tables to calculate relative survival via the Pohar-Perme method.</p> Results <p>Over 10,294 person-years of follow-up, there were 15 deaths (1.4%) among divers, of which four were classified as possible diving-related. No cardiovascular deaths were recorded. The annual diving-related mortality rate was 38.9 per 100,000 divers. Compared with the general population, our cohort of divers had significantly higher 10-year relative survival (101.9%, 95% CI 101.2–103.0). Divers also showed a lower prevalence of obesity, hypertension, and smoking compared to the general population.</p> Conclusions <p>The DIVE-PFO diver cohort demonstrated better long-term survival than the general population.</p>