Limited data regarding the cause of the age-related decrease in survival times in patients with Hodgkin disease are available. In a retrospective study of a nonselected population of patients with Hodgkin disease, the authors evaluated which factors contributed to the age-related prognostic effect in this disease. The survival curves of 182 patients were compared, and survival time was found to decrease markedly after the age of 50 years. Differences in disease characteristics between older and younger patients were small and not statistically significant. Significantly fewer older patients received adequate treatment (34% versus 2%), and they were less likely to have complete disease remission (61% versus 90%). However, the relapse-free survival time of patients with complete disease remission was not significantly different from that of younger patients, 50% of all patients being free of disease after 10 years. Intercurrent disease did not appear to be responsible for decreased survival times in the elderly (32% versus 26%). The authors conclude that the inability to give adequate treatment seems to be the major determinant of the poorer overall survival time of older patients with Hodgkin disease.