OBJECTIVES: To determine risk factors for pulmonary tuberculosis in Russia. DESIGN: Case-control study of exposure to a variety of risk factors before and during the development of pulmonary tuberculosis. SETTING: Large city in Russia. PARTICIPANTS: Cases were 334 consecutive adults diagnosed as having culture confirmed pulmonary tuberculosis between 1 January 2003 and 31 December 2003. Controls were 334 individuals sampled from a validated population registry, matched for age and sex to the patients with tuberculosis. A questionnaire collected information on potential risk factors. MAIN OUTCOME MEASURES: Risk factors associated with the development of tuberculosis. RESULTS: The main risk factors for tuberculosis were low accumulated wealth (univariate odds ratio 16.70), financial insecurity (5.67), consumption of unpasteurised milk (3.58), diabetes (2.66), living with a relative with tuberculosis (2.94), being unemployed (6.10), living in overcrowded conditions (2.99), illicit drug use (8.74), and a history of incarceration in both pretrial detention centres (5.70) and prison (12.50). CONCLUSIONS: When prevalence of exposure is taken into account the most important factors in the development of pulmonary tuberculosis in Russia are exposure to raw milk and unemployment.