On the basis of the established evaluation index systems for the Yellow River (YR) water quality and city social adaptability, the principal component analysis method combined with entropy weight method was applied to quantitatively reveal the evolution trend of the YR water quality and social adaptability of 11 cities along the YR from 2012 to 2019, and the coupling coordination trend of the two was analyzed. The results showed that the multiyear average YR water quality in most cities in the study area was generally good, except Yuncheng and Hohhot, which lagged behind by nutrient and organic pollution primarily. The social adaptability of most cities showed a fluctuating upward trend, Yuncheng was stable at the lowest level, followed by Heze, and weak economic support was found to be the main reason for the low-level social adaptability of both cities. The two systems, i.e., water quality and social adaptability, were generally in good coupling and intermediate coordinated state, and the YR water quality system had the potential to carry the social and economic development of the cities along the YR, but the social adaptability system fell short in generating enough social restoration in response to the potential water environment deterioration of the YR. Heze, Hohhot and Yinchuan were primarily coordinated, Yuncheng was barely coordinated, and there existed one-way or even two-way constraints between the two systems.