Objective To analyze the influencing factors of cholecystolithiasis among Tibetan residents living at extreme altitude. Methods From Aug. 10 to 17, 2023, Nima County People’s Hospital in Nagqu, in collaboration with Tibetan-aid doctors, organized physical examinations for Tibetan residents in Jiwa Township. The physical examination data were collected, and the general information and dietary habits of the examinees were recorded. Based on the results of abdominal ultrasound examination, the 448 enrolled participants were assigned to a cholecystolithiasis group (106 cases) and a non-cholecystolithiasis group (342 cases). Additionally, multivariable logistic regression analysis was conducted to investigate the factors influencing the occurrence of cholecystolithiasis among Tibetan residents. Results There were significant differences in age, weight, body mass index, systolic blood pressure, diastolic blood pressure, finger pulse oxygen, and educational level between the 2 groups (all P＜0.05). The results of multivariate logistic regression analysis showed that age (odds ratio ［OR］ ＝1.062, 95% confidence interval ［CI］ 1.020-1.106), weight (OR＝1.120, 95% CI 1.067-1.176), smoking (OR＝4.751, 95% CI 1.627-13.869), cholesterol (OR＝1.429, 95% CI 1.129-1.810), amount of butter tea drink (OR＝2.123, 95% CI 1.656-2.721), alanine transaminase (OR＝1.045, 95% CI 1.028-1.062), low educational level (OR＝6.994, 95% CI 2.615-18.702), fatty liver (OR＝4.409, 95% CI 1.499-12.968) and meat-based diet (OR＝3.725, 95% CI 1.255-11.055) were correlated with cholecystolithiasis. Conclusion The incidence of cholecystolithiasis among Tibetan residents living at extreme altitude may be related to various factors mentioned above, which provides clues for the prevention, early diagnosis, and treatment of local cholecystolithiasis.