The narrow-width steel box girder is an important type of steel–concrete composite bridge structure, which is usually composed of reinforced concrete wing plates, narrow steel boxes partially injected with concrete, and shear connectors that promote shear force transfer. The utilization of narrow-width steel box girders, augmented by partially filled concrete, embodies the synthesis of steel and concrete elements, fostering structural efficiency. Moreover, its attributes, including reduced structural weight, diminished vertical profile, enhanced load-bearing capacity, and augmented stiffness, have prompted its gradual integration into bridge engineering applications. In this study, the calculated values of shear strength under three current design codes were reviewed, and the shear failure phenomena and its determinants of narrow-width steel box–ultra-high-performance concrete (UHPC) composite beams under negative bending moment conditions were investigated, which were mainly determined by shear span ratio, concrete wing plate, UHPC steel fiber content, UHPC plate thickness, and transverse partition inside the box. Concurrently, this paper evaluates two innovative structural designs, including a double-narrow steel box girder and a three-narrow steel box girder. In addition, strategies to reduce crack formation under the negative bending moment of long-span continuous narrow and wide box girder abutments are discussed, and we show that this measure can effectively control the formation of cracks to support the negative bending moment zone. At the same time, the scope of the application of a narrow-width steel box girder composite bridge is reviewed, and the conclusion is that a narrow-width steel box girder is mainly used in small-radius flat-curved bridges or widened-ramp bridges with a span of 30 m or more in interworking areas and in the main line with a 60–100 m span in mountainous or urban areas. Finally, the research direction of the shear resistance of the UHPC–narrow steel box girder under negative bending moments is proposed.