Paleoepidemiology of cribra orbitalia: Insights from early seventh millennium BP Con Co Ngua, Vietnam

Tianyi Wang, Clare McFadden, Hallie Buckley, Kate Domett, Anna Willis, Hiep H. Trinh, Hirofumi Matsumura, Melandri Vlok, Marc F. Oxenham* (Corresponding Author)

*Corresponding author for this work

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Objectives: We test the hypothesis that the condition(s) leading to the development of cribra orbitalia at Con Co Ngua, an early seventh millennium sedentary foraging community in Vietnam, effectively reduced the resilience of the population to subsequent health/disease impacts. An assessment of both the implications and potential etiology of cribra orbitalia in this specific population is carried out. Methods: The effective sample included 141 adults aged ≥15 years (53 females, 71 males, and 17 unknown sex) and 15 pre-adults aged ≤14 years. Cribra orbitalia was identified by way of cortical bone porosity of the orbital roof initiated within the diplöic space, rather than initiated subperiosteally. The approach is also robust to the misidentification of various pseudo-lesions. Resultant data was analyzed using Kaplan–Meier survival analysis. Results: Median survival is higher in adults aged ≥15 years without cribra orbitalia than those with this lesion. For the pre-adult cohort, the opposite pattern is seen where median survival is higher in those with cribra orbitalia than those without. Conclusion: Adults displayed increased frailty and pre-adults increased resilience with respect to cribra orbitalia. The differential diagnosis for a survival analysis of adults and pre-adults with and without cribra orbitalia included iron deficiency anemia and B12/folate deficiency, parasitism (including hydatid disease and malaria) in addition to thalassemia. The most parsimonious explanation for observed results is for both thalassemia and malaria being the chief etiological agents, while appreciating these conditions interact with, and can cause, other forms such as hematinic deficiency anemias.

Original languageEnglish
Pages (from-to)250-261
Number of pages12
JournalAmerican Journal of Biological Anthropology
Issue number2
Early online date3 Apr 2023
Publication statusPublished - Jun 2023

Bibliographical note

Grant sponsors: Australian Research Council DP110101097, FT120100


  • anemia
  • hunter-gatherers
  • malaria
  • paleoepidemiology
  • Southeast Asia
  • thalassemia


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