Objectives Pesticides are crucial for agricultural development but can be harmful to humans. We conducted a study to investigate the association between pesticide use and liver injury.

Methods We recruited participants ≥40 years from a district with two agricultural regions where water caltrops and mangoes are cultivated. A random sample of 200 residents from each region was selected, and prevalence ratios (PR) for abnormal liver tests were compared.
Results A total of 331 individuals participated (participation rate: 82.8%), with 151 from the water caltrop region and 180 from the mango region. Most participants were ≥60 years and predominantly females. Pesticide users had a higher risk of abnormal liver tests [PR 1.74, 95% confidence interval (CI) 1.15–2.62]. Stratified analyses showed higher risks among those with a positive HBsAg test (PR 2.50, 95% CI 1.34–4.64) or a positive anti-HCV Ab test (PR 10.61, 95% CI 6.00–18.77). Multivariable analysis identified a positive HBsAg test [adjusted PR (PR_adj) 3.21, 95% CI 1.38–7.48], a positive anti-HCV Ab test (PR_adj 23.52, 95% CI 11.30–48.96), and upward pesticide spraying (PR_adj 3.39, 95% CI 1.52–7.54) as independent risk factors for abnormal liver tests.

Conclusions Pesticide use was associated with a higher risk of liver injury, particularly among upward sprayers and those with hepatitis B or C infection. The abnormal liver test cases attributable to upward pesticide spraying in this population might be as large as hepatitis B, supporting the importance of pesticide exposure.

Key terms agricultural worker; hepatitis; liver injury; occupational exposure; pesticide; Taiwan