In order to objectively evaluate the water resources utilization efficiency of urban agglomerations in the Yellow River Basin and analyze the reasons for the difference in water resources utilization efficiency, seven major urban agglomerations in the Yellow River Basin were taken as the research objects. With the GDP, population, and regional water consumption in 48 large- and medium-sized cities from 1989 to 2018 used as the statistical indicators, the super-SBM model was employed to assess the static water resources utilization efficiency, and the dynamic decomposition of the efficiency was conducted with the Malmquist index. Then, the Tobit model was used to analyze the driving factors of the water resources utilization efficiency. The results show that the water resources utilization efficiency in seven large urban agglomerations has increased since 1989, with a significant increase since 2000; water conservation and technological progresses jointly promote the increase of the Malmquist index, economic development plays a remarkable role in improving the water resources utilization efficiency in the Yellow River Basin, while the industrial structure and population density show inhibiting and slightly inhibiting effects, respectively.