This study comprehensively assesses the extreme disaster risk faced by Chinese urban agglomerations and optimizes disaster risk management strategies to enhance their disaster resilience and sustainable development. The focus is specifically on droughts, floods, and earthquakes. The integration of resilience risk elements and set pair analysis (SPA) is employed to obtain risk assessment results for different urban agglomerations, including hazard, exposure, vulnerability, and disaster prevention and mitigation capabilities. The study explores the contributions of important indicators, such as exposure, vulnerability, and disaster prevention and mitigation capabilities, in disaster risk assessment, as well as their performance in various risk-prone urban areas. Comparative analysis of the assessment results for different urban agglomerations under various disaster types reveals varying levels of risk in droughts, floods, and earthquakes across different regions. Some areas exhibit higher hazard, exposure, or vulnerability levels, necessitating strengthened disaster prevention and mitigation measures. Regions with high exposure, low vulnerability, and strong disaster prevention and mitigation capabilities may face lower earthquake disaster risk, while regions with low exposure, high vulnerability, and weak disaster prevention and mitigation capabilities may face higher earthquake disaster risk. Moreover, the Comprehensive SPA model and Interval-valued SPA model outperform traditional SPA methods in assessing the existing flood risk level in Chinese urban agglomerations. The integrated model plays a significant role in predicting earthquake disasters, demonstrating the best predictive performance. This study provides essential reference data for urban disaster prevention and mitigation efforts, aiming to enhance urban resilience and disaster resilience capabilities.