Migratory journeys and tuberculosis risk.

After decades of decline, tuberculosis case rates in New York City more than tripled between 1978 and 1992. While the number of cases of those born in the United States declined after 1992, the proportion of immigrant tuberculosis cases continued to increase and reached 58 percent in 1999. This article questions the biomedical explanation of immigrant tuberculosis as being imported from immigrants' countries of origin. Illness narratives of illegal Chinese immigrants with tuberculosis detailing risks associated with migratory journeys are presented. The social and cultural nature of the concept of risk, as well as the adverse implication of biomedical identification of immigrants as being at higher risk of tuberculosis, are also discussed. The author concludes that the dominant biomedical explanation of immigrant tuberculosis could be modified with the incorporation of the migratory process as a risk factor.