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. Author manuscript; available in PMC: 2025 Mar 1.
Published in final edited form as: Res Aging. 2024 Aug 30;47(2):140–150. doi: 10.1177/01640275241274316

Volunteering and Risk of Heart Attack in Later Life: The Moderating Role of Purpose in Life?

Mallory J Bell 1,2, Kenneth F Ferraro 1,2
PMCID: PMC11659029  NIHMSID: NIHMS2026827  PMID: 39212301

Abstract

Objectives:

We investigate whether volunteering is associated with a reduced risk of first heart attack in later life and whether purpose in life moderates this relationship.

Methods:

Cox proportional hazards were used to examine seven waves of data (2006–2018) from the Health and Retirement Study–a nationally representative survey of adults 50 years and older (N = 5,079).

Results:

Volunteering a moderate number of hours was associated with a 46% lower risk of heart attack compared to non-volunteers. The association between high time-commitment volunteering and heart attack risk was contingent on level of purpose in life: compared to non-volunteers, people with high purpose in life who volunteered 100 + hours had the lowest risk of heart attack.

Discussion:

Meaningful volunteer activities may be one way for older adults to reduce their risk of heart attack.

Keywords: volunteering, cardiovascular health, purpose in life, prosocial activities

Introduction

Research on social determinants of health suggests that prosocial activities, such as volunteering, may be protective against an array of deleterious health outcomes in later life (Morrow-Howell, 2010). Volunteering in later life is prevalent in the United States, with nearly one in four adults age 65+ volunteering for a religious, health, education, or sports-related organization (Anderson et al., 2014). Volunteering contributes to the broader community and may also provide health benefits for the individual engaging in the prosocial activity.

Studies that examine the relationship between formal volunteering and health in adulthood report salubrious effects for physical (Tang, 2009) and mental health (Musick & Wilson, 2003). Particular attention has been given to whether volunteering reduces the likelihood of cardiovascular risk factors such as such as hypertension (Burr et al., 2011; Sneed & Cohen, 2013; Tavares et al., 2013) and systemic inflammation (Bell et al., 2022). Relatively few studies, however, prospectively examine the relationship between volunteering and heart attack risk. Given that each year over 600,000 U.S. adults experience a first heart attack, it is surprising that few studies have examined whether volunteering reduces the risk of heart attack, also known as an acute myocardial infarction (Tsao et al., 2023).

Motivation for volunteering and experience as a volunteer also may be related to potential health benefits. Many older adults may be motivated to volunteer as part of leaving a legacy or paying it forward (Omoto & Snyder, 1995). Others may simply take on the role during retirement to stay active (Ekerdt, 1986). The former may be seeking a role that allows for expression of purpose in life, and we investigate whether volunteers with high purpose in life receive additional health benefits from the prosocial activity. Indeed, past studies reveal that having a strong sense of purpose in life is associated with favorable cardiovascular health (Cohen et al., 2016; Kim et al., 2013). Thus, the current study builds on this literature to examine whether purpose in life moderates the effect of volunteering on risk of first heart attack in later life.

Theoretical Framework and Background

Volunteering is one health promoting activity that many older adults choose to continually engage in during later life (Anderson et al., 2014; Fried et al., 2004). Volunteering is associated with health in three ways. First, volunteering can serve as a platform for individuals to expand their social networks and increase access to social support, both of which exert a significant, positive influence on health in later life (Anderson et al., 2014; Berkman et al., 2000; Boen & Yang, 2018; Fried et al., 2004; Umberson & Montez, 2010). Social support can benefit one’s health by providing informational, material, and psychosocial resources (Cohen, 2004).

Second, whereas volunteering is typically focused on the good of others or noble social objectives, it is also a prosocial activity that may increase health promoting behaviors, particularly physical activity (Anderson et al., 2014; Fried et al., 2004; Han et al., 2017; Varma et al., 2016). For example, results from a randomized control study of the health implications of volunteering reported that volunteers had higher levels of physical activity—measured by step count—compared to non-volunteer controls (Varma et al., 2016). Being physically active in later life is a modifiable behavior that provides noteworthy protection against cardiovascular problems, including hypertension and heart attack (Diaz & Shimbo, 2013; Tian & Meng, 2019). In addition, members of one’s volunteering network often model behaviors that are conducive for cardiovascular health, resulting in a contagion effect (Smith & Christakis, 2008; Umberson & Montez, 2010).

Third, volunteering may be associated with a lower risk of heart attack in later life because it gets under the skin to benefit health. Stated differently, empirical evidence reports that volunteering is advantageous for multiple physiological systems, including the cardiovascular system (Bell et al., 2022; Brown & Brown, 2015; Burr et al., 2016; Kim et al., 2023; Schreier et al., 2013). For example, using data from the Health and Retirement Study and the National Social Life, Health, and Aging Project, Bell et al. (2022) and Kim and Ferraro (2014) report that volunteering is associated with lower C-reactive protein—a biomarker of inflammation indicative of heightened risk for heart attack (Sakkinen et al., 2002).

Volunteering and Health

Extensive empirical research on volunteering and health has been conducted over the last four decades that provides convincing evidence that volunteering is a health promoting role. For example, volunteering is associated with favorable physical (Tang, 2009), mental (Musick & Wilson, 2003), and cognitive health (Infurna et al., 2016). In terms of cardiovascular health, Burr et al. (2016) reported that volunteering may get under the skin to lower a series of metabolic biomarkers and results from Estrella et al. (2020) indicated that volunteers were more likely to have favorable cardiovascular health profiles compared to non-volunteers.

While some studies examine the association between volunteer role and health, others emphasize the relationship between volunteer hours and health. The results are somewhat mixed, especially for cardiovascular health. For example, two studies reported that a moderate amount of annual volunteer hours (i.e., <100 hours) was associated with lower hypertension risk; and volunteering more than 100 hours was not associated with hypertension (Burr et al., 2011; Tavares et al., 2013). On the other hand, some studies report that health benefits were accrued among high time-commitment volunteers only. For example, Sneed and Cohen (2013) found that volunteering 200 or more hours was required to reduce the risk of hypertension. Similarly, results from Han et al. (2017) revealed that older adults who volunteered 100 or more hours annually had a lower risk of incident cardiovascular disease (CVD). Volunteering fewer hours was not associated with lower risk of CVD but was associated with lower non-CVD mortality compared to non-volunteers. Given the divergent findings in prior studies, we examine how volunteer hours are associated with risk of heart attack and specify the following research question:

  • RQ1: Is the number of volunteer hours associated with risk of heart attack in later life?

Purpose in Life and Health

Purpose in life is indicative of health and well-being in later life yet is underutilized in the volunteering literature. Although level of purpose in life may decline in later life, having purpose in life remains salient to mental and physical health for older adults (AshaRani et al., 2022). Given that purpose in life is associated with favorable cardiovascular health outcomes (Cohen et al., 2016; Kim et al., 2013), we analyze whether purpose in life moderates the relationship between volunteering and first heart attack in later life. Perhaps purpose in life enhances the beneficial effect of volunteering. Alternatively, volunteering with little purpose in life could diminish the salutary effects of volunteering and add unnecessary stress or strain to one’s life.

Kim and colleagues (2019) argued that purpose in life is beneficial for cardiovascular health because it can help to buffer against cardiotoxic stress. That is, older adults with high purpose in life may be at lower risk of heart attack because they “either perceive stressors as less difficult or are less reactive to stressors” (Kim et al., 2019, p. 135). Moreover, purpose in life may buffer against heart attack risk because older adults with high purpose in life are less likely to engage in unhealthy coping mechanisms, such as smoking, excessive alcohol consumption, or physical inactivity (Kim et al., 2019). Other research also supports purpose in life as a buffer against deleterious circumstances. For example, a longitudinal study examining the effects of age on cognitive function reported that purpose in life moderated the relationship between age and cognitive decline such that older adults with greater purpose in life received greater protection (Kim, G. et al., 2019). Given purpose in life’s capacity to enhance health, we specify the following research question:

  • RQ2: Does the relationship between volunteer hours and risk of heart attack vary by sense of purpose in life?

Contributions

Despite the extensive amount of research on volunteering and health, there are two important limitations in the existing literature that we address in this study. First, although the relationship between volunteering and cardiovascular health is well documented, studies on volunteering and heart attack per se are rare. Instead, researchers tend to examine the relationship between volunteering and cardiovascular disease, operationalized as hypertension (Burr et al., 2011), biomarkers that increase risk of cardiovascular disease (Bell et al., 2022; Burr et al., 2016), or a combination of one or more of the following: heart attack, angina, congestive heart failure, or stroke (Burr et al., 2018; Han et al., 2017). Combining heart attack with other indicators of cardiovascular disease means that it is impossible to isolate the influence of volunteering on heart attack. It is important to focus more specifically on the relationship between volunteering and heart attack given its high incidence: a heart attack occurs every 40 seconds in the United States (CDC, 2022). Additionally, it is important to examine potential prosocial activities that reduce the risk of first heart attack because experiencing one heart attack increases the risk of subsequent heart attacks (Jernberg et al., 2015).

Two, although results from past research generally support the favorable relationship between greater purpose in life and an array of health outcomes, we are unaware of any study that examines whether the effect of volunteering on heart attack risk is moderated by level of purpose in life. To address these gaps and advance the volunteering-and-health literature, we use data from a large longitudinal study to investigate whether (1) volunteering is associated with lower risk of first heart attack in later life and (2) whether the relationship between volunteering and heart attack varies by sense of purpose in life. Importantly, we give careful attention to how volunteer hours are associated with heart attack risk.

Research Design

Data

The present study uses seven waves of data (2006–2018) from the Health and Retirement Study (HRS), a nationally representative study of adults in the United States. The HRS is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan. Longitudinal data for the current study is based on the 2018 HRS Tracker File (V2). Data on the independent and dependent variables, as well as the covariates, are measured in the HRS Core survey, which is completed every two years. Data on purpose in life are from the 2006 Psychosocial Questionnaire, which includes information on well-being, lifestyle, social relationships, personality, work, and beliefs, and was completed by a random half sample of HRS respondents who completed the Core survey.

We limited our analytic sample to respondents who met the following criteria: (a) completed both the 2006 HRS Core survey, the 2006 Psychosocial Questionnaire, and were non-missing on at least three of the purpose in life items (N = 7520) (b) did not report having a heart attack, coronary heart disease, angina, or congestive heart failure prior to 2006 (N = 5931) and (c) identified as Non-Hispanic White, Non-Hispanic Black, or Hispanic and had no missing values on any of the covariates, yielding a total sample of 5079. See Supplemental Figure 1 for a flowchart of baseline exclusion criteria. Of the 5079 respondents, 3676 (72.38%) were still in the sample in 2018 and 1403 respondents either formally dropped from the study or died.

Measures

The dependent variable for the present study is incidence of first heart attack. In the HRS Core survey, respondents are first asked if they have been diagnosed with a heart condition. If respondents answer affirmatively after the baseline interview, they were asked if they have seen a doctor for their heart problem and if they are currently on heart medication. If the answer to either question is yes, respondents are asked if they have had a heart attack in the last two years, as well as what year and month the heart attack occurred.

Two variables necessary for event history analysis were constructed: a censoring variable and a duration variable. Respondents who reported a heart attack between 2006 and 2018 were coded as 1 (0, no occurrence). This study used proxy reports of heart attacks from exit interviews as a method to include respondents who experienced a first heart attack during the observation period but died or became unable to complete the HRS Core survey. 1,060 proxy reports provided information in exit interviews on whether their partner or close family member experienced a heart attack. Of the 169 heart attacks reported from 2006–2018, 54 (31.8%) came from proxy reports in exit interviews.

The second variable needed for event history analysis is duration, which measures the time, in months, respondents spent in the observation period before experiencing a heart attack or leaving the study. In both the Core survey and exit interviews, if the year of heart attack was reported, but month of heart attack was missing, a uniformly distributed random integer was generated to impute a random month of heart attack for the reported year of event, 1–12.

The focal independent variable was volunteer hours at baseline in 2006. The HRS asks respondents if they have “spent any time in the past 12 months doing volunteer work for religious, educational, health-related, or other charitable organizations”. Respondents then reported the number of hours they volunteered in the previous 12 months and, following prior literature, were categorized in three groups: non-volunteers, volunteered 1–99 hours, and volunteered 100 or more hours (Burr et al., 2011, 2016; Han et al., 2017; Tavares et al., 2013). Respondents who reported volunteering 1–99 hours are referred to as moderate time-commitment volunteers while those who report volunteering 100 or more hours are considered high time-commitment volunteers. Non-volunteers served as the reference group.

To measure purpose in life, we used seven-questions from the Ryff Measures of Psychological Well-being (Ryff, 1995). Respondents reported the degree to which they agreed with each question using a six-point Likert scale that ranged from “strongly disagree” to “strongly agree”. Purpose in life items include: “I enjoy making plans and working to make them a reality”; “My daily activities often seem trivial and unimportant to me”; “I am an active person in carrying out the plans I set for myself”; “I don’t have a good sense of what it is I’m trying to accomplish in life”; “I sometimes feel as if I’ve done all there is to do in life”; “I live one day at a time and don’t really think about the future”; “I have a sense of direction and purpose in my life”. Negatively worded items were reverse coded (i.e., the second, fourth, fifth, and sixth items). We then averaged the scores across items to create an index of purpose in life, 0–5, with higher scores indicating higher purpose in life. Following HRS recommendations, those who were missing on more than three purpose-in-life questions were omitted from the analysis.

Supplementary analyses that examined the volunteer by purpose in life interaction revealed large confidence intervals—likely because so few respondents reported having zero purpose in life (see Model 5 of Supplemental Table 1). Therefore, purpose in life was transformed into terciles based on sample distribution: low, medium, and high. Respondents with low purpose in life scored between zero and 3.14 and served as the reference group. Respondents with medium and high purpose in life had scores of 3.15–4.14 and 4.15–5, respectively. Creating categories of purpose in life helps to elucidate whether a threshold of purpose in life is required to accrue health benefits. Other researchers have also used purpose in life categories (Hafez et al., 2018; Kim et al., 2014, 2020; Musich et al., 2018; Shiba et al., 2022).

We do not treat our volunteering and purpose in life as time-varying because data on these variables are collected at unequal intervals. We can determine the month in which one experiences a heart attack, but volunteer activity is asked every two years while purpose in life items were asked only every four years. The asymmetry for when questions were asked limits the utility and appropriateness of treating volunteering and purpose in life as time varying.

Several covariates were included in the analyses to isolate the effect of volunteer hours, including gender, race/ethnicity, age (50–100), education (0–17 years), and wealth. Gender was a binary variable with men as the reference group and women coded as 1. In terms of race/ethnicity, respondents self-reported if they identified as Non-Hispanic White, Non-Hispanic Black, or Hispanic; White respondents served as the reference group. Wealth is a continuous variable calculated by estimating participants’ net worth and subtracting debt. Because of the wide distribution of wealth values, the variable was reported in 10,000s and transformed by taking the cube root. We also adjusted for level of perceived social support. The HRS uses four sets of three questions to measure social support from (1) spouses (2) children (3) family and (4) friends. For each domain, HRS respondents were asked: “How much do they really understand the way you feel about things”; “How much can you rely on them if you have a serious problem”; “How much can you open up to them if you need to talk about your worries”. Respondents reported the degree to which they agreed with each question on a four-item Likert scale. Responses on social support items were averaged across relationship types so respondents with fewer than four relationships were not penalized.

Health indicators and lifestyle factors included as covariates were physical activity, body-mass index (BMI), smoking behavior, diabetes, hypertension, and heavy drinking. A self-reported physical activity scale gathered information on both frequency and intensity of physical activity. Participants were asked how often they participated in mild, moderate, and vigorous physical activity. The physical activity measure weighted the type of activity by the intensity based on metabolic equivalent recommendations and was a continuous measure that ranged 0–17.6. Participants who scored a zero on the physical activity measure did not engage in mild, moderate, or vigorous activity, while those who scored 17.6 engaged in mild, moderate, and vigorous activity every day. BMI was separated into three categories: underweight or normal (BMI <25), overweight (25 ≤ BMI <30), and obese (BMI ≥ 30). Respondents with a normal or underweight BMI were the reference group. Smoking status was measured using three categories: never smoked (reference group), former smoker, and current smoker. Diabetes and hypertension were both self-reported and were coded as 1 (has the condition) or zero (does not have the condition). Drinking behavior was dichotomized, such that 1 represented heavy drinking, defined as 15 or more drinks per week for men and 8 or more drinks a week for women; respondents who were not heavy drinkers were coded as zero and were the reference group.

Analytic Strategy

Cox proportional hazards models were used to prospectively examine predictors associated with risk of first heart attack. Cox models are an appropriate method to analyze longitudinal panel data and “offer richer information… [and] provide more appropriate techniques for exploring causal relationships” (Blossfeld et al., 2019). To test whether the proportional hazards assumption was violated, both Schoenfeld residuals and graphical assessments were used (i.e., Kaplan-Meier curves). The test of Schoenfeld residuals and Kaplan-Meier curves provided evidence that the proportional hazards assumption was upheld. We used five nested models to examine the relationship between volunteer hours, purpose in life, and risk of heart attack.

We used AIC and BIC values across the five nested models to examine comparative model fit. AIC values largely decreased across nested models and plateaued in models four and five. BIC values, on the other hand, slightly increased, likely because BIC values penalize for additional complexity and prefer more parsimonious models. We argue that the additional complexity is necessary to parse out the relationship between volunteering, purpose in life, and heart attack.

Supplementary Analyses

We did two series of supplementary analyses to examine potential sources of bias. First, we compared results using survey weights based on participation in the leave behind psychosocial questionnaire and results without survey weights. Conclusions do not change with the inclusion of survey weights and, therefore, we do not use survey weights in the results presented below.

Second, we used the two-step Heckman method to investigate whether non-random mortality selection influenced our findings (Heckman, 1979). We first conducted a probit analysis to identify who survived to the final wave (2018), with the following variables as predictors in the selection equation: gender, race, marital status, depression, and cancer. We then used the results from the probit model to create a mortality selection variable based on the inverse Mills ratio (λ) and specified it as a covariate in the Cox regression models. As shown in Model 1 of Supplemental Table 2, there is selection bias due to mortality in the simplest model, but Models 2–5 show that there is no selection bias after adjusting for the covariates when modeling heart attack. Thus, the conclusions were unchanged by the Heckman adjustment (see Supplemental Table 2).

Results

Sample Descriptive Statistics

Descriptive statistics for all variables are presented in Table 1. During the 144 months of observation, 169 (3.33%) respondents reported having a heart attack. Average duration in the observation period was about 116 months. Overall, 21% of respondents reported volunteering 1–99 hours and 18% reported volunteering 100 or more hours at baseline in 2006. In terms of purpose in life, 35.68%, 35.83%, and 28.49% of respondents reported low, medium, and high purpose in life, respectively.

Table 1.

Descriptive Statistics for the Analytic Sample, HRS (N = 5079).

Variable Range Percentage Mean (SD)
Heart attack 0,1 3.33
Duration 1–144 116.33 (40.37)
Volunteer hours
 Did not volunteera 61.76
 1–99 hours 20.67
 100+ hours 17.56
Purpose in life
 Lowa 35.68
 Medium 35.83
 High 28.49
Race/Ethnicity
 Non-hispanic whitea 79.23
 Non-hispanic black 12.94
 Hispanic 7.84
Age 50–100 67 (9.79)
Women 59.81
Education 0–17 12.77 (3.00)
Wealth −11.09–28.37 6.08 (3.60)
Social support 0–3 2.15 (0.52)
Physical activity 0–17.6 8.05 (4.07)
BMI
 Normala 29.81
 Overweight 38.57
 Obese 31.62
Smoking behavior
 Nevera 44.44
 Former 42.29
 Current 13.27
Diabetes 17.19
Hypertension 53.59
Heavy drinker 6.34
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Note. information on all independent variables were measured in 2006. Heart attacks occurred between 2006 and 2018.

a

Reference group.

In supplementary analyses, logistic regressions were conducted to identify characteristics that predicted volunteer role occupancy (see Supplemental Table 3). Tests of average marginal effects were performed so interpretations could be discussed in predicted probabilities, rather than odds ratios. On average, after adjusting for other variables in the model, women, years of education, wealth, and social support all predicted a higher predicted probability of volunteering. Black respondents had a 0.09 and 0.16 higher predicted probability of volunteering compared to White and Hispanic respondents, respectively, while Hispanic respondents had a 0.07 lower predicted probability of volunteering than White respondents. In terms of health characteristics, former smokers have a 0.05 lower predicted probability of volunteering than those who have never smoked. Current smokers had a 0.19 and 0.15 lower predicted probability of volunteering than non-smokers and former smokers, respectively. Diabetes, hypertension, being obese or overweight, and drinking heavily had no effect on the predicted probability of being a volunteer and thus were not included in Supplemental Table 3.

Volunteer Hours and Hazard of First Heart Attack

Hazard ratios of five nested Cox proportional hazard models are presented in Table 2. Hazard ratios for covariates are not shown (results available upon request). In the unadjusted model (i.e., Model 1), respondents who volunteered 1–99 hours had a 59% lower hazard of first heart attack compared to non-volunteers while respondents who volunteered 100 or more hours had a 39% lower risk of heart attack compared to non-volunteers. Model 2 adjusts for demographic characteristics and reveals that respondents who spent 1–99 hours volunteering had about half the risk of heart attack compared to non-volunteers (HR = 0.50; p < .05). The relationship between volunteering 100 or more hours and heart attack is non-significant. The favorable relationship between volunteering 1–99 hours and heart attack is slightly attenuated after adjusting for relevant health characteristics (i.e., Model 3), yet is still associated with a 46% lower risk of heart attack compared to non-volunteers.

Table 2.

Cox Proportional Hazards Models Predicting First Heart Attack: Hazard Ratios and 95% Confidence Intervals.

Variable Model 1 unadjusted Model 2 demographic adjusteda Model 3 health adjustedb Model 4 PIL adjustedc Model 5 vol hours × PILd
Volunteer hours
 1–99 hours 0.41***
(0.25, 0.66)		 0.50**
(0.31, 0.82)		 0.54*
(0.33, 0.89)		 0.55*
(0.33, 0.90)		 0.54
(0.23, 1.26)
 100+ hours 0.61*
(0.40, 0.95)		 0.76
(0.48. 1.19)		 0.80
(0.51, 1.27)		 0.82
(0.52, 1.30)		 1.47
(0.74, 2.93)
Purpose in life
 Medium 1.00
(0.71, 1.42)		 1.03
(0.69, 1.55)
 High 0.77
(0.50, 1.21)		 1.03
(0.63, 1.69)
Volunteer hours × PILe
 Vol 1–99 hours × medium 1.33
(0.45, 3.96)
 Vol 1–99 hours × high 0.54
(0.12, 2.32)
 Vol 100+ hours × medium 0.54
(0.20, 1.40)
 Vol 100+ hours × high 0.25*
(0.07, 0.87)
 AIC 2796.979 2750.287 2742.597 2744.983 2746.400
 BIC 2810.047 2809.09 2847.136 2862.589 2890.141
 Likelihood ratio χ2 18.65 79.34 101.03 102.64 109.23
 N 5079 5079 5079 5079 5079
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*

p < .05;

**

p < .01;

***

p < .001.

a

Adjusts for race, age, gender, education, wealth, and social support.

b

Adjusts for demographics + physical activity, BMI, smoking status, diabetes, hypertension, and heavy drinking.

c

Adjusts for demographics + health + PIL.

d

Adjusts for demographics + health + PIL × Volunteer Hours.

e

PIL = Purpose in life.

Among the demographic variables in Model 3 (results not shown) women and respondents with greater wealth had a lower hazard of heart attack compared to men and respondents with less wealth (HR = 0.52, p < .001; HR = 0.95, p < .05, respectively). Older respondents, current smokers, and people with diabetes had a higher risk of heart attack compared to younger respondents, respondents who had never smoked, and people without diabetes (HR = 1.05, p < .001; HR = 1.71, p < .05; HR = 1.95; p < .001, respectfully).

We also investigated how the relationship between volunteering and heart attack may vary by purpose in life. Model 4 introduces purpose in life; results indicate that purpose in life is not associated with heart attack. However, Model 5 of Table 2 presents the volunteer hours and purpose in life product terms and reveals that the association between high time-commitment volunteering and heart attack risk varies by level of purpose in life (HR = 0.25; p < .05). That is, high time-commitment volunteers who report high purpose in life are less likely to experience a first heart attack compared to non-volunteers with low purpose in life. Product terms for lower levels of volunteer hours and purpose in life were non-significant.

To illustrate the volunteering by purpose in life interaction, we present Figure 1, which illustrates the survival function for two groups: high time commitment volunteers who report high purpose in life and non-volunteers who report low purpose in life. The figure reveals that high time-commitment volunteers who reported a high sense of purpose in life were more likely to remain in the sample throughout the observation period without having a heart attack compared to non-volunteers with low purpose in life. More specifically, compared to non-volunteers with a low purpose in life, high time-commitment volunteers with high purpose in life were about 2.5% more likely to remain in the sample without experiencing a heart attack by the end of the observation period.

Figure 1.

Figure 1.

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Survival function for first heart attack. Note: PIL = Purpose in Life. Survival function refers to the percentage of respondents who remain in the sample without reporting a heart attack.

Discussion

Disentangling the relationship between volunteer hours, purpose in life, and heart attack is important given that heart attack is one of the leading causes of mortality and morbidity among older adults (Reed et al., 2017). Results of our study reveal that the effect of high time-commitment volunteering on risk of heart attack varies by sense of purpose in life such that respondents who volunteered 100 or more hours and reported high purpose in life accrued the greatest health benefits. Our results do not suggest, however, that one must volunteer at a high time-commitment to receive some protection against heart attack. Rather, earlier models indicate that volunteering a moderate number of hours was associated with a substantially lower heart attack risk compared to non-volunteers. Other researchers report parallel findings for the relationship between moderate volunteering and hypertension (Burr et al., 2011; Tavares et al., 2013).

Our results demonstrate the importance of interactive models for understanding the relationship between volunteering time-commitment and health. Specifically, our results indicate that moderate time-commitment is protective against heart attack, but high-time commitment volunteers also stand to benefit if they also report high purpose in life. Indeed, our results suggest that purpose in life may be more protective for high time-commitment volunteers compared to respondents who spend less time in prosocial activity. Stated simply, high purpose in life is not required for respondents who volunteer a moderate number of hours to receive health benefits; but high purpose in life is essential for high time-commitment volunteers to receive protection against heart attack. Perhaps the main effect of high time-commitment volunteering was non-significant because volunteering many hours without a high degree of purpose in life adds unnecessary stress or strain to one’s life. Nonetheless, the inclusion of purpose in life may help contextualize results of other studies that report a favorable relationship between volunteering and health only among individuals who dedicate a preponderance of hours to the prosocial activity (Burr et al., 2016; Sneed & Cohen, 2013).

Our study adds to the volunteering-and-health literature because it is one of a few longitudinal studies that examine volunteering and heart attack in later life. The results presented here largely support the findings of longitudinal studies on volunteering and cardiovascular health outcomes among older adults. Indeed, Burr et al. (2018) reported that women who volunteer have a 22% lower hazard of incident cardiovascular disease among, conceptualized as having a heart attack or stroke. Similarly, results from Han et al. (2017) revealed volunteering was associated with lower risk of incident cardiovascular disease, conceptualized as heart attack, coronary heart disease, angina, congestive heart failure, or stroke. While these two studies are exemplary in many regards, we are left questioning whether volunteering influences all indicators of cardiovascular disease equally. That is, the effect of volunteering on cardiovascular disease could be biased downwards if, perhaps, volunteering is strongly associated with heart attack risk, but has no relationship with congestive heart failure. The results from Burr et al. (2018) and Han et al. (2017) provide evidence for the relationship between volunteering and favorable cardiovascular health, and we build on these studies and demonstrate that volunteering is associated with a specific indicator of cardiovascular health: heart attack.

Volunteering may be associated with a lower risk of heart attack because volunteers are more likely to avoid deleterious behaviors and adopt healthy behaviors due to encouragement from fellow volunteers or from the volunteer activity itself. Indeed, health promoting behaviors can spread through social networks, and volunteering has been shown to increase level of physical activity (Fried et al., 2004; Umberson & Montez, 2010). Additionally, volunteering may increase one’s social support, which can provide older adults with material and psychosocial resources that benefit health (Cohen, 2004). Because opportunities for social interaction and social support may decline in later life, it is important to investigate ways for older adults to compensate for potential losses and volunteering may be one promising activity to do so (Czaja et al., 2021; Ferraro & Farmer, 1995).

Purpose in life may enhance the health promoting role of high time-commitment volunteering because it “gets under the skin” to lower risk of heart attack by lowering allostatic load (Zilioli et al., 2015) or preventing the development of Type 2 diabetes through improved glucose regulation (Hafez et al., 2018). High time-commitment volunteers with high purpose in life may be better equipped to deal with, or buffer against, stressful circumstances (Kim et al., 2019). Because purpose in life tends to be associated with future-oriented behavior, high time-commitment volunteers who also have high purpose in life also might be more hesitant to engage with unhealthy behaviors (Hooker et al., 2018).

Limitations

The current study has two main limitations. First, the HRS asks respondents if they have volunteered in the previous 12 months, even though respondents complete the Core survey every 24 months. Thus, the 2006 volunteering information used for this study may count sporadically engaged volunteers as non-volunteers. Future studies may consider measuring repeated waves of volunteer activity to examine whether the effect of volunteering on heart attack is more pronounced among sustained volunteers.

Second, the results of this study should be understood in the context of potential selection effects. Is volunteering associated with lower risk of first heart attack because older adults with greater well-being are more likely to occupy the volunteer role compared to older adults with worse health? We attempted to avoid selection on the focal independent and dependent variable at three different stages of our research. First, we excluded HRS respondents who reported a previous heart condition at baseline, including heart attack, coronary heart disease, angina, and congestive heart failure. Second, we conducted a series of average marginal effects to examine predictors of volunteer role occupancy. Several health conditions and lifestyle factors had no relationship with whether one volunteered, including diabetes, hypertension, being obese or overweight, and drinking heavily. Further, we also analyzed potential bias due to selective survival with a Heckman adjustment. Although we found evidence of selection in earlier models, there was no evidence of selection after adjusting for covariates and substantive conclusions were unchanged by the Heckman adjustment. These results provide some evidence that selection was not the main factor leading to our conclusions, but selection remains an important consideration in studies of prosocial behavior and health.

Conclusions

The results presented in this study contribute to the volunteering and health literature in important ways. Results revealed that volunteering a moderate number of hours was associated with a 46% lower risk of heart attack compared to non-volunteers. The present study also illustrates the role that high purpose in life plays in accruing health benefits among high time-commitment volunteers: in multiplicative models, older adults who volunteered 100 or more hours and reported having high purpose in life had significantly lower risk of heart attack compared to individuals who did not volunteer and who had low purpose in life. Engaging in prosocial activities and having a high sense of purpose in later life may be one method to attenuate risk of first heart attack.

Supplementary Material

Supplementary

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by a grant from the National Institute on Aging to K. Ferraro (AG043544).

Biographies

Kenneth F. Ferraro is distinguished professor of sociology and the founding director of the Center on Aging and the Life Course at Purdue University. His recent research uses a life course framework to examine health inequality, especially racial and ethnic disparities, and the cumulative effects of early exposures on adult health.

Mallory J. Bell is a PhD candidate at Purdue University, where she will graduate with a dual title PhD in Sociology and Gerontology. Her research focuses on prosocial activities and health and racial health disparities among people with chronic illnesses; her dissertation examines diminishing returns on social determinants of health for Black older adults.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

Data Availability Statement

Data available upon request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary
NIHMS2026827-supplement-Supplementary.pdf (309KB, pdf)

Data Availability Statement

Data available upon request.

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