Cincinnati chili is a Mediterranean-spiced meat sauce used as a topping for spaghetti or hot dogs. It originated with immigrant restaurateurs from Macedonia who were trying to expand their customer base by moving beyond narrowly ethnic styles of cuisine.

Slavic Macedonians Tom and John Kiradjieff immigrated from the town of Hrupishta (today's Argos Orestiko in Greece), fleeing the Balkan Wars, ethnic rivalries, and bigotry, in 1921. They began serving a "stew with traditional Mediterranean spices" as a topping for hot dogs

which they called "coneys" in 1922 at their hot dog stand located next to a burlesque theater called the Empress, which they named their business after. Tom Kiradjieff used the sauce to modify a traditional Greek dish, speculated to have been pastitsio, moussaka or saltsa kima

to come up with a dish he called chili spaghetti. He first developed a recipe calling for the spaghetti to be cooked in the chili but changed his method in response to customer requests and began serving the sauce as a topping,

eventually adding grated cheese as a topping for both the chili spaghetti and the coneys, also in response to customer requests.