The aim of this study was to relate ambient air pollution levels to mortality in Auckland, New Zealand. We used urban airshed modelling and GIS-based techniques to quantify long-term exposure to ambient air pollution levels and associated mortality. After adjusting for age, sex, ethnicity, socio-economic status, and urban/rural domicile there was a 1.3% (95%CI: 1-1.5%) increase in non-external cause mortality, and 1.8% (95%CI: 1.5-2.1%) increase in circulatory and respiratory causes per 1 microg/m(3) increase in annual average NO(2). Based on these exposure-response relationships and applying an annual average threshold of 13 microg/m(3), the average annual (for 1996-1999) number of people estimated to die from non-external causes and circulatory and respiratory causes attributable to air pollution in Auckland is 268 (95% range: 227-310) (3.9% of total all cause deaths) and 203 (95% range: 169-237) (5.9% of total circulatory and respiratory deaths) per year, respectively. The number of attributable deaths found in this study are consistent with a previous New Zealand risk assessment using a different methodology, and is approximately twice the number of people dying from motor vehicle accidents in the region, which is on average (1996-1999) 103 per year. The GIS-based exposure maps identify high exposure areas for policy developers and planners in a simple and realistic manner. Taken together with overseas studies the study provides additional evidence that long-term exposure to poor air quality, even at levels below current standards, is a hazard to the public health.