Improving the industrial carbon emission efficiency in regions where coal is the main resource can reduce the reliance on fossil energy, promote the clean and efficient utilization of coal and the development and utilization of renewable energy, and is one of the important ways to achieve economic low-carbon transformation and regional sustainable development. Quantifying the industrial carbon emission efficiency and its influencing factors in coal-dominated regions is a necessary prerequisite for achieving efficiency improvement. This study selected a certain province in the central region and several coal-dominated cities and prefectures under its jurisdiction as the research samples. Data enveloping analysis was used to evaluate the carbon emission efficiency and trend, and the Tobit regression model was utilized to deeply explore the key influencing factors of carbon emission efficiency. Research has found that although the energy structure dominated by coal has a strong inhibitory effect on carbon emission efficiency, the overall carbon emission efficiency of industrial scale and above in China's coal-dominated regions still shows an upward trend. The scale effect can reduce the carbon emissions per unit output and have a positive impact on carbon emission efficiency. In addition, promoting the low-carbon transformation of the energy structure, accelerating the upgrading of the industrial structure, and expanding the scale of enterprises all contribute to enhancing the industrial carbon emission efficiency in coal-dominated regions.