One difference is the atmospheric pressure,it is very low at high altitudes.
So the cabin pressure should be kept suitable for the passengers.
Pressurization becomes increasingly necessary at altitudes above 10,000 feet (3,000 m) above sea level to protect crew and passengers from the risk of a number of physiological problems caused by the low outside air pressure above that altitude. For private aircraft operating in the US, crew members are required to use oxygen masks if the cabin altitude stays above 12,500 ft for more than 30 minutes, or if the cabin altitude reaches 14,000 ft at any time. At altitudes above 15,000 ft, passengers are required to be provided oxygen masks as well. On commercial aircraft, the cabin altitude must be maintained at 8,000 ft or less. Pressurization of the cargo hold is also required to prevent damage to pressure-sensitive goods that might leak, expand, burst or be crushed on re-pressurization.