GaN-based ultraviolet-light-emitting diodes (UV LEDs) with 375 nm emission were grown on different-sized patterned sapphire substrates (PSSs) with ex situ 15-nm-thick sputtered AlN nucleation layers by metal–organic chemical vapor deposition (MOCVD). It was observed through in situ optical reflectance monitoring that the transition time from a three-dimensional (3D) island to a two-dimensional (2D) coalescence was prolonged when GaN was grown on a larger PSS, owing to a much longer lateral growth time of GaN. The full widths at half-maximum (FWHMs) of symmetric GaN(002) and asymmetric GaN(102) X-ray diffraction (XRD) rocking curves decreased as the PSS size increased. By cross-sectional transmission electron microscopy (TEM) analysis, it was found that the threading dislocation (TD) density in UV LEDs decreased with increasing pattern size and fill factor of the PSS, thereby resulting in a marked improvement in internal quantum efficiency (IQE). Finite-difference time-domain (FDTD) simulations quantitatively demonstrated a progressive decrease in light extraction efficiency (LEE) as the PSS size increased. However, owing to the significantly reduced TD density in InGaN/AlInGaN multiple quantum wells (MQWs) and thus improved IQE, the light output power of the UV LED grown on a large PSS with a fill factor of 0.71 was 131.8% higher than that of the UV LED grown on a small PSS with a fill factor of 0.4, albeit the UV LED grown on a large PSS exhibited a much lower LEE.