The combined impact of urbanization-induced warming and drying on large-scale heat stress disparities remains unknown, with multicity studies using satellite-derived land surface temperature as a proxy for these disparities. Here, using high-resolution urban-resolving numerical model simulations for 2014–2018, we find pervasive disparities in all-sky average maximum summertime air temperature and moist heat stress metrics across US cities, with higher outdoor heat stress exposure in poorer and primarily non-white census tracts. Ninety-four percent of the US urban population (228 million) live in cities where heat stress burdens the poor, with heat stress inequities between white and non-white populations strongly associated with residential segregation. Similarly, historically redlined neighborhoods show higher heat stress than their non-redlined counterparts, demonstrating how historical segregation relates to present-day environmental inequalities. Our results provide quantitative estimates of physiologically relevant heat stress disparities at the US national scale and highlight potential biases when using satellites as a proxy for these.