Does Volunteering Give an Extra Health Boost? Volunteering and High Blood Pressure Among Insured and Uninsured U.S. Adults in Late Midlife

INTRODUCTION: High blood pressure (HBP) is a major predictor of cardiovascular disease, a leading cause of death in the U.S. Growing evidence suggests that formal volunteering in later life is associated with a lower prevalence of HBP; however, it remains unclear whether these benefits extend to adults in late midlife and whether they differ by health insurance status. METHODS: This prospective cohort study analyzed data from the 2012-2018 Health and Retirement Study. The analytic sample included 4,169 respondents between the ages of 50 and 64. Because blood pressure was measured in half the sample in alternating waves, data were pooled across waves. To address selection into volunteering, energy-balance weights were created using participants' pre-baseline (t₀; 2012/2014 subsamples) sociodemographic and health-related characteristics to balance the distribution of these characteristics between volunteers and non-volunteers at baseline (t₁; 2014/2016 subsamples). Weighted Poisson regression models with robust error variance estimated the population-average treatment effects of volunteering on HBP at post-baseline (t₂; 2016/2018 subsamples). Differences in effect estimates between insured and uninsured groups were assessed using seemingly unrelated estimation. RESULTS: Volunteering was associated with a lower prevalence of HBP in the full sample (prevalence ratio (PR)=0.86, p=0.005). In subgroup analyses, compared with non-volunteers, volunteers were less likely to have HBP in both the uninsured (PR=0.64, p=0.005) and insured (PR=0.90, p=0.044) groups. The estimated effects differed significantly across groups (F[1, 4168]=4.05, p=0.044), indicating that volunteering may have a greater influence on reducing HBP prevalence among uninsured individuals than among insured counterparts. CONCLUSIONS: Volunteering may serve as a non-pharmacological, community-based intervention to support cardiovascular health in late midlife. While not a substitute for health insurance, findings suggest that uninsured individuals may derive additional health gains from volunteering.