The association of daily diabetes mortality and outdoor air pollution in Shanghai, China.

* During the past decade, Shanghai, the largest city in China, has undergone the most rapid development and urbanization in its history.

* The traditional coal combustion-related air pollution of Shanghai has improved substantially.

* The level of vehicle-originated air pollution is increasing, however.

* The disease pattern among Shanghai residents has changed considerably.

* The leading causes of death have shifted from infectious diseases to noncommunicable diseases.

* These include tumor, cardiovascular diseases, and diabetes.

* Diabetes has become one of the leading causes of death in Shanghai.

* Mortality from diabetes has increased from 0.52 per 100,000 in 1966 to 16.95 per 100,000 in 1998.

* Diabetics have been suspected to be at higher risk of air pollution-related health events.

* Recently, the relationship has been investigated and confirmed positive in Canada and the United States.

* The authors used a time-series approach to assess the effects of air pollution on daily diabetes mortality.

* They also explored the exposure-response patterns for major air pollutants with respect to diabetes mortality in Shanghai.

* Results showed that the current levels of P[M.sub.10] and N[O.sub.2] in the Zhabei District of Shanghai are associated with the daily death rates from diabetes.

* This study also revealed that air pollution has a greater effect on diabetes mortality than on other causes of death.

* Focusing on the preventable aspects of diabetes mortality--for example, air pollution--could significantly reduce diabetes-related health problems.