This paper takes 287 cities at and above the prefecture level in China from 2000 to 2021 as subjects, based on the ecological footprint theory of water resources, the TAPIO-LMDI model was constructed by using decoupling theory and LMDI method to study the decoupling relationship between water resources utilization and high-quality economic development. The results indicate that there are significant differences in water footprint between different regions in China, but the total water footprint in the country is showing a trend of stabilization, and the ecological profit and loss of water resources have improved during the research period. Overall, the high-quality development index of China’s economy is gradually improving, showing a decoupling from water resource utilization. The decomposition results of decoupling driving factors show that the main factors promoting decoupling include technological and structural factors, while the factors inhibiting decoupling mainly involve the improvement of urbanization rate and the increase of population. It is suggested that water resource management policies should be formulated according to local conditions, water resource utilization efficiency should be improved, and water saving publicity and education should be strengthened.