Thomas Shey
Legend
Those people ignore it like they ignore Golarion or Midguard. But the game itself builds upon that lore and everything is compatible with itself rather than contradicting itself.
Though the degree of moving parts and special-casing in D&D components can make it more than trivial to ignore those settings even if you want to. I like PF2e, but I'd find it a chore to use it for a non-Golarian based setting because there are so many assumptions from that baked into it.