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The prevalence of CMS was higher in females than in males, and this difference was statistically significant (<jats:italic>p<\/jats:italic>\u2009=\u20090.043). The frequency of CMS increased with age\u2010at\u2010death. Bilateral CMS occurred more frequently than unilateral CMS. The differences in the prevalence of CMS in the Etruscan (700\u2013450\u2009<jats:sc>bce<\/jats:sc>), Samnite (450\u2013375\u2009<jats:sc>bce<\/jats:sc>), and final pre\u2010Roman (375\u2013200\u2009<jats:sc>bce<\/jats:sc>) phases of occupation were not statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>In combination with viral and bacterial infections, occupational activities (metallurgy, ceramic and textile production, and agriculture) and environmental factors (volcanic ash, marshy environments, and sub\u2010Saharan dust plumes) likely stimulated respiratory disease and resultant CMS in the inhabitants of Pontecagnano. This study provides a framework for future research on CMS and respiratory diseases in the Mediterranean region, in relation to environmental, climatic, and anthropogenic influences. The limited number of individuals per period prevented a proper diachronic analysis. Osteoarcheological assemblages from the Mediterranean region should be systematically analyzed for CMS to increase understanding of how climate, environment, industrialization, and urbanicity affected human health through time.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ajpa.70059","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T05:00:49Z","timestamp":1747112449000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Environment, Occupation, and Chronic Maxillary Sinusitis in Pre\u2010Roman Italy"],"prefix":"10.1002","volume":"187","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8828-0112","authenticated-orcid":false,"given":"Bianca","family":"Casa","sequence":"first","affiliation":[{"name":"Division of Paleopathology, Department of Translational Research and new Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9108-039X","authenticated-orcid":false,"given":"Valentina","family":"Giuffra","sequence":"additional","affiliation":[{"name":"Division of Paleopathology, Department of Translational Research and new Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3048-0493","authenticated-orcid":false,"given":"Giulia","family":"Riccomi","sequence":"additional","affiliation":[{"name":"Division of Paleopathology, Department of Translational Research and new Technologies in Medicine and Surgery University of Pisa  Pisa Italy"},{"name":"Max Planck Institute of Geoanthropology  Jena Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"volume-title":"History of Human Life Span and Mortality","year":"1970","author":"Acs\u00e1di G. 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