[Objective] Effects of urban land expansion on the ecosystem health of urban agglomeration in the lower Yellow River basin were studed. A scientific ecosystem health evaluation model was constructed to identify the spatial and temporal evolution characteristics of the ecosystem health status, in order to provide the prerequisite for formulating effective ecological protection strategies. [Methods] The VORS model was developed with urban agglomeration in the lower Yellow River basin as the study region, and the grid was used as the study unit to dynamically assess the ecosystem health of the urban agglomeration in 2000, 2010 and 2020. [Results] ① From 2000 to 2020, the mean ecosystem health index decreased from 0.325 in 2000 to 0.320 in 2020, and the standard deviation increased from 0.106 in 2000 to 0.112 in 2020, the health level of the ecosystem in the study area generally showed a slightly decreasing trend. Areas with high levels of ecosystem health were healthier, while those with low levels were deteriorating. ② The spatial heterogeneity of the ecosystem health level in the study area was significant, and the spatial distribution of all levels was concentrated. In most areas extending from the middle of the study area to the northeast, the ecosystem health level was poor, accounting for up to about 74%, and the overall ecosystem health level was fragile. ③ The Moran’s I was 0.512, 0.522 and 0.543 in 2000, 2010 and 2020, respectively. The overall distribution of ecosystem health in the study area had a positive spatial agglomeration effect, with significant spatial dependence. [Conclusion] The overall level of ecosystem health in the urban agglomeration of lower Yellow River basin has decreased, the ecosystem health is not optimistic, ecological environmental protection and construction need to be strengthened, and in the future, people should focus on improving the level of ecosystem services.