The eastern coastal areas of China have high-density population, developed society and economy, and large water pollution emissions. How to reduce water pollution and realize the coordinated development of the economy and environment has become the national focus. Effective environmental policies should consider regional differences in development stage and sustainability performance. Here, we first analyzed the water pollution emissions intensity of the eastern coastal areas of China and the urgency of emissions reduction using 8-year environmental statistics from 2003 to 2010. We characterized development stages of the eastern coastal areas based on the relationships between water pollution emissions intensity and economic development. Further, we built a coordination degree index of economic development and water environment protection as a measure of sustainability. Results show that water pollution emissions intensity decreases as the economy grows from 2003 to 2010. The less-developed regions have a better coordination degree than some more-developed regions, especially those most-developed ones (e.g., Shanghai show more pressures on long-term sustainability than Hebei). The less-developed regions should take advantage of economic growth to invest more advanced environment protection technologies. The more-developed regions need to upgrade its economic structures and municipal infrastructures. Overall, the study provided a comprehensive approach to understand regional difference in development stage and sustainability performance in the eastern coastal region of China as well as the need of different environmental policies to reduce water pollution emissions. (C) 2016 Elsevier Ltd. All rights reserved.