In the context of rapid urbanization, urban population differentiation has become increasingly pronounced. Regional development strategies based on growth scenarios often lead to continuous expansion, regardless of urban population status. Such “one-size-fits-all” models exacerbate resource waste and negatively impact urban land use efficiency (ULUE). This study aims to explore the mechanisms by which urban population growth and shrinkage (UPGS) affect ULUE, with the goal of enhancing ULUE and promoting sustainable urban development. We analyzed 34 prefecture-level cities in China’s three northeastern provinces. First, we identified UPGS using population data. We then employed a three-stage SBM-DEA model to measure ULUE from 2000 to 2020. Spatial analysis methods were used to examine the spatiotemporal characteristics and correlations between UPGS and ULUE. Additionally, mediating effect models and spatial Durbin models were utilized to empirically test the impact processes, mechanisms, and spatial heterogeneity. Our findings reveal that: (1) Over the past 20 years, urban population shrinkage in northeastern China has intensified, and significant regional disparities in urban development are evident. (2) Population growth positively influences ULUE, while population shrinkage inhibits its improvement. (3) Economic development, technological innovation, and industrial structure upgrading are key factors in enhancing ULUE in this region, while the impact of public services on ULUE varies significantly at different stages of urban development. (4) Economic development, technological innovation, and industrial structure upgrading exhibit spatial spillover effects, whereas public services are constrained by regional limitations, resulting in minimal spatial spillover effects. To foster coordinated regional development, this study proposes policy recommendations, including strengthening support for resource-dependent cities, optimizing the allocation of public resources, and promoting technological innovation and industrial diversification.