<p>The northwest inland cotton region is China’s largest cotton-producing area. However, due to its unique climatic and geographical conditions, there is a lack of clear indicators to assess the effectiveness of pest control measures, making it challenging to identify the primary pest management issues in the region. This study systematically evaluates the effectiveness of pest and disease control in recent years by analyzing long-term data from ecological network sites and provincial-level pest and disease occurrence records from the national cotton-growing regions. Using linear regression models, we examined the relationship between the area under control and the area affected, as well as the relationship between recovered losses and potential losses. Our findings indicate that the overall pest and disease control performance in the northwest inland cotton region is below the national average. While the region’s control of cotton seeding blight and cotton fusarium wilt is on par with other major cotton-producing areas, significant deficiencies exist in managing major pests and diseases, such as <i>Bemisia tabaci</i>, cotton red spider mites, and cotton verticillium wilt. Furthermore, some pests and diseases are subjected to excessive control efforts. Despite a general decline in cotton pest and disease incidence nationwide, the prevention and control efficiency in the northwest inland cotton region has weakened. Based on these findings, we recommend increased attention to pest and disease monitoring and management in the region and the development of a localized, region-specific pest control system.</p>