Northeast China’s sandy region is an arid and semi-arid zone highly susceptible to climate change. Investigating the long-term changes in the Northeast China sandy land (Northeast China sandy land, DBSL) landscape can provide an important basis for the ecological restoration of this region. This study analyzed long-term remote sensing data of the DBSL from 1980 to 2022 and explored the spatial pattern, evolution, and driving mechanisms. In 2022, vegetation was mainly distributed in the northwest, center, and southwest, covering a total area of 30,508.82 km2. Areas with high and medium vegetation cover showed strong aggregation characteristics and were mainly distributed in the southwest, whereas those with low vegetation coverage were highly dispersed and widely distributed in the central region. Lakes were widely distributed in the northwest and central regions, with a total area of 2736.43 km2. In the last 42 years, the vegetation cover decreased by 24.48%. Areas with high and medium vegetation coverage decreased in size, and those with low vegetation coverage first increased and then decreased, with overall decreases of 35.35%, 19.16%, and 6.88%, respectively. The overall area of the DBSL showed various degrees of degradation. Shrinking and dry lakes were concentrated in the sandy hinterland. The lake landscape changed significantly from 1990 to 2010, with a decrease in lake area of 27.41%. In contrast, the sandy area increased by 25.65%, indicating a high degree of desertification. However, from 2005 to 2022, desertification decelerated. The most important factors driving the evolution of the DBSL were socio-economic factors. The increase in human disturbance will have a certain impact on the landscape changes in the region in the short term. The national policy of returning farmland to fields and grasslands will affect the increase of vegetation and lake landscape area in the short term, and the sand area and excessive animal husbandry will be reduced. This study provides a scientific basis for ecological restoration and sustainable development in Northeast China.