Prevalence and risk factors of occupational falls from heights in Thailand during 2016–2018

Falls from heights (FFH) have remained the second leading cause of occupational fatalities among Thai workers for decades. Recent national-level analyses identifying risk factors for fatal FFH in Thailand are lacking. This study examined the prevalence of occupational FFH and identified factors associated with fatal versus non-fatal outcomes using national workers’ compensation data. We conducted a retrospective cross-sectional analysis of 17,046 occupational FFH cases reported to the Workmen’s Compensation Fund, Ministry of Labour, Thailand, between 2016 and 2018. Descriptive statistics were computed across five severity categories, and multivariate logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for fatal versus non-fatal falls. Of 17,046 cases, 293 were fatal. Male workers had higher odds of fatal falls than female workers (aOR 2.45, 95% CI 1.24–4.84). Odds increased progressively with age, from aOR 1.90 (95% CI 1.05–3.47) at 35–44 years to aOR 6.87 (95% CI 1.56–30.28) at 65+. Micro-sized enterprises showed higher odds than large enterprises (aOR 1.75, 95% CI 1.17–2.62).Construction-related sources were associated with substantially higher odds than object sources (aOR 10.26, 95% CI 1.26–83.65).The Object reference category included only a single fatal case, so estimates for the other source categories should be interpreted with caution due to sparse-data instability. Head and neck injuries (aOR 27.53, 95% CI 10.18–74.46) and multiple organ failure (aOR 168.12, 95% CI 37.28–880.43) showed the strongest associations; wide confidence intervals warrant cautious interpretation. Fatal occupational FFH in Thailand was most strongly associated with older male workers, micro-sized enterprises, construction sources, and high-impact injury patterns. The findings support targeted safety training and evidence-informed fall-protection practices for these high-risk groups.