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Waterborne diseases are a serious concern in the sister cities of El Paso, Texas, and Ciudad Juárez, Chihuahua, where many residents still lack access to plumbing. After using a relative risk method to illustrate the characteristics of neighborhoods at risk for waterborne diseases based on lack of plumbing, we ran spatial regression models predicting lack of plumbing to uncover similarities and differences between the two cities. In terms of similarities, lower mean education and higher proportions of young children were associated with lacking plumbing in both cities. Lower population density and higher proportions of female-headed households were significant only in Juárez, and proportion renting was negatively associated with lacking plumbing in Juárez, but positively associated in El Paso, pointing to differences in socio-spatial structure between the cities. In framing this issue as an environmental injustice, this study draws attention of the existence of households lacking plumbing in the United States and Mexico. [ABSTRACT FROM AUTHOR]