Intersecting socio-demographic transformations and warming climates portend increasing worldwide heat exposures and health sequelae. Cooling adaptation via air conditioning (AC) is effective, but energy-intensive and constrained by household-level differences in income and adaptive capacity. Using statistical models trained on a large multi-country household survey dataset (n = 673,215), we project AC adoption and energy use to mid-century at fine spatial resolution worldwide. Globally, the share of households with residential AC could grow from 27% to 41% (range of scenarios assessed: 33-48%), implying up to a doubling of residential cooling electricity consumption, from 1220 to 1940 (scenarios range: 1590-2377) terawatt-hours yr.⁻¹, emitting between 590 and 1,365 million tons of carbon dioxide equivalent (MtCO₂e). AC access and utilization will remain highly unequal within and across countries and income groups, with significant regressive impacts. Up to 4 billion people may lack air-conditioning in 2050. Our global gridded projections facilitate incorporation of AC’s vulnerability, health, and decarbonization effects into integrated assessments of climate change.