This swift progression of urbanization has led to increasingly prominent conflicts over the use of land, particularly around its supply and demand. Researchers, both in China and internationally, have underscored the inherent interconnection between urbanization and land utilization. This relationship has gradually become more complex with the development of urbanization. With the implementation of the Yellow River Basin’s strategy to preserve the environment while ensuring high-quality development, the Yellow River Basin has become a focal point of attention for numerous scholars. This study centers on the 57 county-level administrative divisions within the Gansu segment of the Yellow River Basin. We employed an extensive array of methodologies, such as GIS technology, the entropy method, data envelopment analysis, the coupling coordination degree model, and the panel vector autoregressive model. We established an index system and a measurement model to evaluate the degree of urbanization and the efficiency of land use. We also investigated the coupling coordinated dynamics between these two variables, to further explore the dynamic interplay between urbanization and land use and reveal their underlying mechanisms. The conclusions are as follows. The urbanization level and efficiency of land use in the Gansu section of the Yellow River Basin have exhibited a consistent upward trajectory, albeit at levels that are not particularly high, indicating substantial room for improvement in the future. The level of coupling coordination between urbanization and land use efficiency in the Gansu section of the Yellow River Basin has shown a generally upward trend. However, the overall coordination level remains relatively low, characterized by an imbalance, with “high coupling but low coordination”. Regarding spatial distribution patterns, considerable disparities exist in the level of coordination development, which generally decreases from the eastern toward the western regions. A strong reciprocal and interactive relationship exists between the urbanization level and land use efficiency. An elevated level of economic urbanization can initially stimulate land use efficiency. Similarly, the improvement in the level of population urbanization, social urbanization, and ecological urbanization tends to exert a restraining influence on the augmentation of land use efficiency. Conversely, the enhancement of land use efficiency makes a distinct contribution to promoting the elevation of the urbanization level.