Trees contribute greatly to urban environments and human well-being, yet relatively little is known about the extent to which a rising incidence of tree insect pests and pathogens may be affecting these contributions. To address this issue, we undertook a systematic review and synthesis of the diverse global empirical evidence on the impacts of urban tree insect pests and pathogens, using bibliographic databases. Following screening and appraisal of over 3000 articles from a wide range of fields, 100 studies from 28 countries, spanning 1979–2021, were conceptually sorted into a three-part framework: (1) environmental impacts, representing 95 of the studies, including those reporting on tree damage, mortality, reduced growth, and changes in tree function; (2) social impacts were reported by 35 of studies, including on aesthetics, human health, and safety hazards; and (3) economic impacts, reported in 24 of studies, including on costs of pest management, and economic losses. There has been a considerable increase in urban impact studies since 2011. Evidence gaps exist on impacts on climate-regulating capacity, including temperature regulation, water retention, soil erosion, and wind protection, but also on specific hazards, nuisances, human well-being, property damages, and hazard liabilities. As a knowledge synthesis, this article presents the best available evidence of urban tree insect / pathogen impacts to guide policy, management and further research. It will enable us to better forecast how growing threats will affect the urban forest and plan for these eventualities.