Abstract Background Extreme heat is an important public health concern. Heat stress exposure and related adaptive capacity are not equally distributed across social groups, generating thermal inequality. We implemented a systematic review to answer the question: In the general population, what is the effect of social disadvantage on exposure to subjective and objective heat stress and adaptive capacity to prevent/reduce exposure to heat stress? Methods We searched for peer-reviewed journal articles published between 2005 and 2024. Screening and data extraction were conducted by one reviewer, with a second screening and extracting 10% for comparison. Synthesis included identification and description of specific social groups unequally exposed to heat stress and with lower adaptive capacity as well as a narrative description of the evidence and identification of research gaps. Results We identified 114 relevant publications. 53% included evidence on objective heat stress, 19% subjective heat stress, and 58% adaptive capacity. Nearly half came from North America (47%), 24% from Asia, and 17% from Europe. Publishing increased over time, from 0 articles in 2005 to 20 articles in 2023. Most studies considered socioeconomic status (SES) (87%), while fewer focused on race/ethnicity or other social factors. Across global regions, lower-SES populations, immigrants, and racial/ethnic minorities are generally more exposed to heat stress and have lower adaptive capacity, and lower-SES and minority neighborhoods are generally hotter and less green. Most studies of objective heat stress use imprecise measures, such as land surface temperature, which are not representative of experienced temperatures. Conclusions This review summarizes the available evidence on inequalities in heat stress exposure and adaptive capacity for the first time and identifies important research gaps related to heat stress measurement and social factors beyond SES. Key messages • Heat stress exposure and related adaptive capacity are not equally distributed across social groups, generating thermal inequality. • Social inequalities must be considered during climate change adaptation planning.