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It would be interesting to understand why UT and NM fare so much better than MA or NY – or VT and DE for that matter.
Utah is an easy one, the low lung cancer rate is because the huge population of Mormons don't smoke at all.

There are also a lot of morms in Idaho, I was surprised to see how much higher the rates are.

Possibly also less air pollution ?
Maybe, it's hard to say, lots of the population lives around SLC and Provo.

Provo lies in the middle of a basin, surrounded by huge mountains that create a trap for smog inversion layers.

You'd need data to know, not my anecdata :)

Air pollution, just as "second hand" smoke, is way overblown as a risk factor for lung cancer. Nothing compares, not even close, to sending foreign particles, the end results of combustion, straight to your lungs, like smokers do. The result of years and years of this sludge accumulating on your alveoli is going to be bad, you don't have to be oncologist to see it. And that's why I always tell my pot head friends to beware of what will happen to their lungs 20, 30 years from now. "Muh, it's a natural plant!!!" If you burn it and send the results of the combustion to your lungs on a daily basis, good luck. I don't know about vaping, but in my opinion, if it's not air, pure and simple air, it should not be entering your lungs. Vaping probably is orders of magnitude safer than smoking, but who knows. We never know what we don't know before it happens.
Uh-huh. Looking at a sibling comment where Salt Lake City was claimed to have "pretty bad air" I got interested in how bad it actually was.

https://aqicn.org/city/utah/salt-lake-city/

So… something like 5-10 µg/m³ PM 2.5 for most of the year, with rare spikes up to 30 µg/m³ for short periods of time.

If that's your definition of air pollution, then sure. One cigarette a year will probably do more damage to you than that.

I live in a really polluted place, with yearly PM 2.5 average of ~100 µg/m³ (daily mean of hundreds of micrograms per m³ in winter, and short spikes up to 1500 µg/m³ for hours at a time), and high levels of toxic gases (SO₂, NO₂, H₂S, HCl, HF, and a few others).

Literally everyone here suffers from chronic bronchitis, including myself. (Never smoked.) Deaths from lung cancer and COPD among non-smokers are commonplace. I don't have the exact statistics (the government doesn't publish absolute numbers), but incidence of lung cancer is claimed to be around 3× the national average (which is already bad compared to developed countries).

I believe it's also pretty bad in industrial Chinese cities, although they have so much smoking population it's difficult to differentiate.

SLC has pretty bad air because of the geography. Although not everyone lives there.
Yup, and it's getting worse. This is largely driven by drought and the dessication of the Great Salt Lake. The dust pulled off the basin is also toxic due to heavy metals (most notably arsenic), industrial and agricultural runoff, and the remnants of algal blooms. Here's one recent article covering the topic: https://www.deseret.com/opinion/2022/6/29/23188005/opinion-t...
There are also a lot of Mormons in Western Wyoming.
Mormons don't smoke.
This is literally the answer. My brother's a data scientist at a large health insurance company and this is a subject we've discussed at length. In short, because of the large Mormon population in Utah, the state has shockingly good statistics on a very wide range of disease incidences, health-related quality of life outcome measures, etc. With respect to health and longevity, it pays not to drink, smoke, or do drugs (surprise, surprise).

Other interesting tidbit – his health insurance company (and I expect all others) took a substantial hit 2019-2020 from the initial phase of the pandemic. Come 2021-2022, large proportions of the unhealthiest segments of the population had passed away; covid + comorbidities puts you at a much greater risk of dying than covid alone. They integrated this fact into their modeling and, given that these people would no longer require care (e.g. dialysis, ER visits), predicted that utilization would go down substantially and, now providing for an overall healthier population, the company would be more profitable that year relative to pre-pandemic years. This turned out to be an accurate prediction.

except diabetes. No prohibition on sugar (and it replaces a lot of other vices, see "Dirty Soda" culture)
Hadn't heard of this. Yikes – dirty sodas sound pretty vile.
Note that Arizona, New Mexico, and Wyoming also have relatively large LDS populations.
I mean smoking is a factor, sure...but that doesn't explain why NM, who has a highish average smoking rate, is near the bottom. Same for how AL, who has a high smoking rate, is middle of the pack.
Also demographics and ethnicity possibly? Utah has a 24% Hispanic population and NM is 49% Check out this study:

  https://www.sciencedirect.com/science/article/pii/S1658387621000297
"Conclusion Hispanic ethnicity was associated with better survival in NSCLC. This survival advantage is likely the result of complex interactions amongst several physical, social, cultural, genomic, and environmental factors."

Well put, these things are always complex.

Do people have basements? Radon?
The vast majority of UT houses have basements. Is radon a factor in lung cancer?
Living in a country that has a lot of natural radon in some places, very definitely yes. New houses over here must be built in a way that mitigates radon exposure, unless that particular region is low-risk.
At risk of going wildly off topic from the post, I’d suggest that for anybody with disposable income, the value proposition of buying some air quality sensors is amazing.

I installed some a month or two ago, and they caught alarmingly high radon levels in my basement that I’m now working to address. But also they catch more mundane things, like “oh, I tend to get headaches in the afternoon, which happens to be when the co2 levels are super high in my office”.

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Which brand of sensors do you recommend?
I’ve been happy so far with Airthings. They have a variety of sensors with different price points / features (seems like most except the Mini will do radon), the mobile app is decent, and there’s a HomeAssistant integration for it.
Yes, and radon is a fairly high awareness thing and tests are both readily available and often free. I got it done shortly after moving into my house.
Map of roughly risk of radon: https://www.epa.gov/sites/default/files/2015-07/documents/zo...

Given that lung cancer is driven by a) smoking, then b) radon, one would expect some level of correlation here.

That map makes it looks like the borders of Missouri were decided based on radon risk. Which is not what I think actually happened when they drew those borders.

So, no, don't believe your map.

The granularity of the map seems to be at the county level, so I will guess that the EPA did not gather this data by itself, but rather, rely on self-reported data from each county from each state. A county is a political boundary, so the state of Missouri probably had different testing regulations and methodologies than its neighbors like Iowa and Illinois.
>> so the state of Missouri probably had different testing regulations and methodologies than its neighbors like Iowa and Illinois

Then the map doesn't show risk of radon. It's worthless for that purpose.

"Different political institutions have different standards for what is a radon risk."

It's a map of different political institutions then. That's fine. Just don't try to sell a map of political institutions as a map of radon risk when that is obvious bullshit. I mean it's completely obvious from the boundary.

100% obvious bullshit.

Radon Risk is well established. If it’s higher than a specific limit you need to mitigate. This map just indicates where it is likely to be higher on average based on geology.
I've read that vitamin D can play a role in cancer prevention at a cellular level. Our bodies synthesize vitamin D using UVB in sunlight. You'll notice that most of the states at the bottom of the list (except DC ?!?) are sunny places, so I wouldn't be surprised if that is a contributing factor.
That's an interesting point
It's interesting to me that Kentucky and West Virginia have approximately same percentage of adult smokers. So although obviously cigarettes are the most likely factor by an overwhelming amount, there's probably more contributing factors leading to the differences.

https://www.cdc.gov/statesystem/cigaretteuseadult.html

Those states are the core of coal country.
But don't they mine clean coal now? Coal is safe and clean, shouldn't states with those radioactive nuclear things have more cancer?
Interesting to note:

> Variations in medical care among states may also result in differences in cancer rates. In states where higher percentages of people participate in cancer screenings, more cancers are diagnosed early when the prognosis is often better.

It seems like this data could be impacted such that better healthcare would result in worse cancer rate, since this study naturally counts know cancer rates. That is, it would not necessarily result in literally more incidents of cancer, just the rate as measured.

I would think that if lung cancer goes undiagnosed, it will eventually kill the patient, at which point it would be recorded as a lung cancer case. So I wouldn't expect cancer screening to bias measurement.

Would people who die from metastasized lung cancer not be recorded as having had lung cancer?

How often is an autopsy performed?

I don't know the answer but my guess is that the majority of deaths do not have an autopsy performed, especially in 65+ age range.

Edit -- I looked it up, sounds like ~7% of US deaths have an autopsy currently, so I'd guess that the data is influenced by healthcare quality (I didn't read it, perhaps they try to control for that?).

Appears to correlate with smoking rates and longitude.
It would be nice to see a smoker-adjusted rate.
I posted this article because “In Utah more people die from lung cancer than from any other cancer” is true, while “Utah has the lowest rate of lung cancer among all states” is also true.
my gut reaction is "because Mormons"
To be honest you could add that after any sentence that starts "In Utah..."
It's great to have people comment on their own post to explain the motivation behind.
At a glance, it appears that lung cancer incidence is somewhat negatively correlated with elevation. Perhaps higher elevation enhances lung health, contributing to the results here.
The top two states are in Appalachia. Are you sure about the correlation?
are you saying appalachia is high elevation? The highest "mountain" is a hill compared to the west coast.
Having lived in both Utah and Colorado, and spent time in other high elevation states, I'd say that it is not about the elevation directly, but that elevation tends to exist because of mountains. Mountains draw active, younger people who enjoy outdoor activity. And that demographic does not tend to smoke.
Lots of coal in the high rate states.