Continued climate change is increasing the frequency, severity, and duration of populations' high temperature exposures. Indoor cooling is a key adaptation, especially in urban areas, where heat extremes are intensified—the urban heat island effect (UHI)—making residential air conditioning (AC) availability critical to protecting human health. In the United States (U.S.), the differences in residential AC prevalence from one metropolitan area to another is well understood, but its intra-urban variation is poorly characterized, obscuring neighborhood-scale variability in populations’ heat vulnerability and adaptive capacity. We address this gap by constructing empirically derived probabilities of residential AC for 45,995 census tracts across 115 metropolitan areas. Within cities, AC is unequally distributed, with census tracts in the urban ‘core’ exhibiting systematically lower prevalence than their suburban counterparts. Moreover, this disparity correlates strongly with multiple indicators of social vulnerability and summer daytime surface UHI intensity, highlighting the challenges that vulnerable urban populations face in adapting to climate-change driven heat stress amplification.