Infectious diseases remain a structural challenge for Brazil’s Unified Health System (SUS) due to high demand for hospitalizations, prolonged length of stay, and high mortality rates, directly affecting hospital management and healthcare costs ‒ especially in regions with care inequalities. This study aimed to evaluate the economic impact, case fatality, average length of stay, and distribution of hospitalizations for infectious and parasitic diseases in Pernambuco from 2014 to 2024.

Descriptive ecological study based on secondary data extracted from the SUS Hospital Information System (SIH/SUS), processed between 2014 and 2024. The analysis included number of hospitalizations, total costs paid according to the SUS table, in-hospital deaths, mortality rate (deaths per 100 hospitalizations), average length of stay, sex, race/color, age group, and state administrative divisions (Geres). Data were organized in spreadsheets and tabulated by processing year.

A total of 532,435 hospitalizations for infectious diseases were recorded, with a total cost of R$ 1,480,333,558.00. Three groups accounted for over 87% of this amount: viral diseases (R$ 662.3 million), septicemia (R$ 357.4 million), and bacterial infections (R$ 256.8 million). Average annual costs rose from R$ 70–75 million (through 2019) to R$ 220 million (from 2020 onward), peaking in 2021 (R$ 490 million). A gradual downward trend in expenditures was observed in 2023–2024 (average R$ 97 million). There were 86,175 deaths, with an average in-hospital mortality rate of 16.19 per 100 hospitalizations, ranging from 10.41 (2014) to 19.46 (2021). Average length of stay increased from 7.4 to 9.7 days, with an overall mean of 8.5 days. Adults aged ≥60 years accounted for 62.2% of deaths, while 1,701 occurred in children under 1 year. I Geres (Recife) represented 65.9% of hospitalizations, followed by IV (Caruaru) and VI (Arcoverde). Sociodemographic profile showed 52.4% male and 59% “parda” individuals; 29.2% had missing race/color information.

Infectious diseases generated substantial impact on the SUS in Pernambuco over the analyzed period, with increased costs, mortality, and length of stay, especially after 2020. Regionalization of care, strengthening epidemiological surveillance, and adoption of cost-effective strategies such as vaccination, rapid testing, and vector control are urgent priorities.