Northwest China faces an imbalance between scarce water resources and increasing water use demands for agricultural production and economic growth. However, the shifts in virtual water flow (VWF) patterns in Northwest China and its the driving factors are still unclear. In this study, we employed the Multiregional Input–Output (MRIO) method to investigate the evolution of VWF patterns among Northwest China’s primary, secondary, and tertiary industries and analyze their driving factors through Stochastic Impacts by Regression on Population, Affluence, and Technology (STIRPAT) model. The results show that (1) Northwest China changed from 7.24 × 108 m3 net inflow to 175.70 × 108 m3 net outflow from 2002 to 2007. (2) More than 90 % of virtual water of the primary industry was used locally, but both secondary and tertiary industries depended more on virtual water inflow in Northwest China. (3) The virtual water outflow from Northwest China is mostly to the Jing-Jin Region, followed by the Northern Coast, and the main inflow is from the Central Region. (4) Population, economy, and technology affect virtual water from inflow to outflow, and technological development helps to decrease virtual water flow volumes. In conclusion, dramatic decrease of second and third industries inflow is the main reason for the changes from net inflow to net outflow of Northwest China. Meanwhile, it is feasible to increase technological support to further reducing virtual water consumption in primary industry, and strengthen virtual water trades of secondary and tertiary industrial virtual water inflows by promoting population and economic conditions.