By analyzing the mechanism by which industrial structure adjustment influences the reduction in pollution and carbon emissions (RPCE) in the Yellow River Basin, in this study, we calculated data for the RPCE in 57 prefecture-level cities from 2011 to 2020. Based on the Regression on Population, Affluence, and Technology (STIRPAT) model, we empirically examined factors affecting the RPCE in the Yellow River Basin. Additionally, different scenarios were established in order to simulate and predict the future trend of the RPCE in the Yellow River Basin. In the study, we found the following: (1) The RPCE in the Yellow River Basin shows a positive trend, with lower levels in upstream Gansu and Ningxia and particularly severe conditions in Zhongwei, Shizuishan, and Wuhai, making these key areas for RPCE. (2) Moreover, the RPCE effect of the advanced industrial structure in the Yellow River Basin is superior to that of the rationalized industrial structure, economic growth and population increases are conducive to RPCE, foreign investors in the Yellow River Basin tend to invest more in high-energy-consuming industries, and there is a “pollution haven” effect. (3) In terms of regional heterogeneity, the impact of industrial structure adjustment on the RPCE in the lower and middle reaches is greater than that in the upstream regions. (4) The acceleration of the transformation and upgrading of industry, stabilization of the population growth rate, and promotion of high-quality economic development are the optimal development paths for RPCE in the Yellow River Basin.