East Asia has being heavily affected by the rise in shipping activities in the region, and has led to thousands of deaths annually, according to a study in the Journal of Nature Climate Change.

Increased emissions lead to large adverse health impacts, with 14,500 to 37,500 premature deaths per year.

The study shows that shipping emissions in East Asia accounted for 16 percent of global shipping CO2 in 2013, compared to only four percent to seven percent between 2002 and 2005. China is home to seven out of the 10 biggest ports in the world.

East Asia has the most rapidly growing shipping emissions of both CO2 and traditional air pollutants, but least in-depth analysis. Since large proportion of vessels are registered elsewhere, joint efforts are necessary to reduce emissions and mitigate the climate and health impacts of shipping in the region.

Members of the national shipowners associations of the International Chamber of Shipping had agreed to coordinate a shipping emissions campaign in a bid to lower the impacts of emissions in ports. The European Union also promulgated regulations relative to vessel CO2 emissions.

An OECD paper from 2014 estimated the health and mortality affects of emissions to be even greater than the the Nature article. That paper calculated emissions from shipping to be between two percent and three percent of total global emissions, five percent to 10 percent for sulfur oxide, and 17 percent to 31 percent for nitrogen oxide emissions.

“These emissions have increased at a large pace over recent decades and are expected to increase

rapidly in the future,” the paper noted. “Ports are the places where the impacts of shipping emissions are most noticeable.”

Emissions in ports have been linked to respiratory issues and premature births, the paper noted. “Calculations suggest that shipping-related particulate matter emissions are responsible for approximately 60,000 cardiopulmonary and lung cancer deaths annually, with most deaths occurring near coastlines in Europe, East Asia, and South Asia.

“Surprisingly,” the paper concluded, “little is known about ship emissions in ports, as there remains

a scarcity of studies covering the topic.”