Utah's data highlight that differences exist among states. The general population of Utah is younger than the population of most states in the United States; one third of Utah's general population was aged 17 years or younger, and one fourth was aged 18 to 34 years during the study years. According to the National Vital Statistics Reports, accidents are generally the leading cause of death among people younger than 34 years (11-18,22). The high proportion — almost 60% of Utah residents younger than 34 years — could have affected Utah's data in this study. Age distribution and lifestyle among Utah residents may also affect the lower incidence of cancer in the state. To explain the lower percentages of cancer among deceased adults who had been served by the Massachusetts Department of Mental Health, Dembling et al (3) suggested that the development of cancer might be preempted by early death. A similar explanation could be applied to this study's data from multiple states, especially in view of the younger average ages at time of death for the public mental health clients.
