August 13, 2025Open Access

Associations between pesticide exposure and hepatobiliary disease among agricultural workers in the Northeastern region of Thailand: a cross-sectional study

Key Points

There is a significant association between abnormal serum cholinesterase levels and hepatobiliary diseases, with higher prevalence in Sakon Nakhon.
Among 917 agricultural workers, 46% had hepatobiliary disease and 89% displayed abnormal serum cholinesterase levels.
Data collection involved serum cholinesterase testing across eight provinces in Northeastern Thailand from 2016-2024.
Public health interventions are crucial to reduce pesticide exposure and its associated health risks among agricultural workers.

Abstract

Occupational exposure to pesticides has been linked to hepatobiliary diseases, particularly liver cancer and cholangiocarcinoma (CCA). In Thailand, pesticides are crucial for agriculture, enhancing crop protection and yields. This study aimed to determine the association between pesticide exposure and the prevalence of hepatobiliary diseases among agricultural workers in Northeastern Thailand. The abdominal ultrasonographic findings of the CCA risk population were retrieved from the Isan cohort. Biological monitoring data on pesticide exposure were collected via serum cholinesterase testing from 8 provinces in Northeast Thailand, including Khon Kaen, Roi Et, Udon Thani, Nong Bua Lamphu, Kalasin, Buriram, Nakhon Phanom, and Sakon Nakhon provinces during 2016-2024. Data was analyzed using descriptive and inferential statistics with the STATA version 11.0 program. Of the 917 agricultural workers, the average age was 54.88 years (SD = 8.53), 552 were female (60.20%), and 365 were male (39.80%). The highest prevalence of hepatobiliary disease (46.03%) and abnormal serum cholinesterase levels (89.42%) among agricultural workers was observed in Sakon Nakhon province. The prevalence of abnormal serum cholinesterase in males (84.11%) was higher than in females (65.76%) (p < 0.001). Multiple logistic regression analyses showed a significantly positive association between abnormal serum cholinesterase levels and hepatobiliary diseases among agricultural workers (ORadj = 3.64, 95% CI = 2.46-5.38, p < 0.001). Our study highlights the association between pesticide exposure, indicated by abnormal serum cholinesterase levels, and an increased risk of hepatobiliary diseases. This finding underscores the importance of targeted interventions and public health policies that focus on educating agricultural workers on safe pesticide handling, promoting awareness campaigns, and implementing surveillance efforts to reduce exposure and mitigate the burden of hepatobiliary diseases, particularly in high-risk populations.

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