Based on the Driver-Pressure-State-Impact-Response (DPSIR) framework, this paper constructs the input, expected output, and unexpected output of China’s sustainable development. This paper calculates the sustainable development efficiency of 31 provinces and cities in China using a super-slack-based measure (SBM) model that eliminates the influence of scale factors through a three-stage data envelope analysis (DEA) approach. Taking the level of science and technology as the control variable, and the relative scale efficiency as the threshold variable, this paper calculates the effects of the absolute scale of labor force, education, economy, enterprise, and transportation on sustainable development efficiency. The results show that: (1) there is an upward trajectory for sustainable development efficiency of China’s provinces and municipalities overall from 0.65 in 2004 to 0.68 in 2017, with significant regional differences in which the ecological efficiency in the Eastern region is 0.26 higher than that of the Central region; (2) it enhances the absolute scale of the labor force, education, and transportation, in order to reduce the inhibition on sustainable development efficiency; and (3) shifts our attention to the promotion of absolute economic scale to the promotion of green economic development, and increases control of polluting enterprises.