Midstream oil and gas infrastructure comprises vast networks of gathering and transmission pipelines that connect upstream extraction to downstream consumption. In the United States (US), public policies and corporate decisions have prompted a wave of proposals for new gathering and transmission pipelines in recent years, raising the question: Who bears the burdens associated with existing pipeline infrastructure in the US? With this in mind, we examined the density of natural gas gathering and transmission pipelines in the US together with county-level data on social vulnerability. For the 2,261 US counties containing natural gas pipelines, we found a positive correlation between county-level pipeline density and an index of social vulnerability. In general, counties with more socially vulnerable populations have significantly higher pipeline densities than with less socially vulnerable populations. In particular, counties in the top quartile of social vulnerability tend to have pipeline densities that are much higher than pipeline densities for counties in the bottom quartile of social vulnerability. The difference grows larger for counties at the upper extremes of pipeline density within each group. We discuss some of the implications for Indigenous communities and others affected by recent expansions of oil and gas infrastructure. We offer recommendations aimed at improving ways in which decision-makers identify and address the societal impacts and environmental justice implications of midstream pipeline infrastructure.