In this paper, we report the fabrication of an multiple-quantum-well (MQW) structure on vicinal sapphire substrates with a very small offset angle of 0–1° by low-pressure metallorganic chemical vapor deposition. Our study demonstrates that the quality of the MQW structure is very sensitive to the offset angle of the vicinal substrate. High-resolution X-ray diffraction analyses demonstrated high-order satellite peaks and clear fringes between them for all MQW structures fabricated, from which the interface roughness (IRN) was estimated. The IRN of the MQW structure fabricated on 0.2° off sapphire substrate was determined as 1.36% of the quantum well layer period. Besides, reciprocal lattice mapping was employed to examine the strain status of the MQW. The lattice relaxation of the same specimen mentioned above was estimated to be . It is therefore manifested that an MQW structure with abrupt interfaces and good layer periodicity was grown. From it, a shortest radiative lifetime of and a lowest fluctuation of in the emission energy of micro-photoluminescence mapping were achieved. In addition, superior material qualities of the whole film fabricated on 0.2° off substrate were recognized by cross-sectional transmission electron microscopy. Based on the results mentioned above, a high-quality MQW blue light, emitting diode (LED) has been fabricated on 0.2° off substrate, which demonstrated a strong room-temperature electroluminescence emission at the wavelength of and with the full width at half maximum of only . The same device also showed an output power of and an external quantum efficiency of 19.2%. Both these characteristics are improved drastically compared with the devices fabricated on the substrates with other offset angles. Conclusively, the use of an appropriately misoriented sapphire substrate is suggested to be effective for elevating the emission efficiency of MQW blue LED fabricated thereon.