Sewer pipes health and failure consequences evaluation are vital to ensure the safety of urban sewer networks. Sewer pipes with low health and severe failure consequences should be the primary focus of daily maintenance and management for drainage authorities. Conversely, sewer pipes with high health and low failure consequences are temporarily not a primary concern, in order to reduce resource wastage within the constraints of limited economic and time resources. Thus, the scientific analysis of their relationships is deemed essential. This paper applies supply-demand balance theory to analyze the relationship. On the supply side, a health Fuzzy Comprehensive Evaluation model (HFCE) is proposed with weighted hierarchies established. On the demand side, a failure consequences FCE model (FFCE) is established. Each sewer pipe's supply-demand balance score is analyzed using matrix multiplication, highlighting two types of imbalanced pipes and sub-districts. Taking the Liangshui River Basin in Beijing as an example, the results show that the health evaluation can identify the spatial distribution of the health of sewer pipes, with low health levels V and IV accounting for 10.23 % and 4.43 %, respectively. The failure consequences evaluation can evaluate the spatial distribution of the severity of sewer pipe failure consequences, with high failure consequences levels V and IV respectively accounting for 10.97 % and 16.77 %. The supply-demand balance analysis identifies the proportion of the first and second types of imbalanced pipes, respectively 14.24 % and 6.80 %. This method, by analyzing the relationship of health and failure consequences, provides a decision-making basis for drainage authorities to prioritize sewer pipe operation management, repair, and maintenance. •Supply-demand balance to identify the relationship of health and failure consequences.•DEMATEL optimized AHP calculated weights by considering inter-indicator relationships.•Improved health evaluation via hydraulic metrics in drainage models, enhancing accuracy.•Identifying low(high) health/high(low) failure consequences areas for drainage authorities.