Factors associated with mortality were examined for 27,370 hip fracture patients aged 65 years or older in Maryland hospitals, using discharge data for 1979-1988. Variables of interest included sociodemography, principal medical and injury diagnoses, E-code, year, disposition, and hospital. For both white males and white females, the hip fracture rate doubled with each 5-year increment in age. The overall proportion who died during hospitalization was 4.9% (n = 1,339). After multivariate adjustment, there remained a substantially increased risk of death for males. The relative odds (RO) of dying for males versus females were 1.6. Other factors associated with high relative odds of dying during hospitalization included the diagnosis of septicemia (RO = 12.3), pneumonia/influenza (RO = 4.9), and digestive system disorder (RO = 3.6). The RO of dying doubled in the presence of cardiac, neoplastic, or cerebrovascular disease. Patients with diagnoses of nervous system or mental disorder, hypertension, anemia, musculoskeletal system disease, or urinary tract infection were at decreased risk of dying. Results of the study suggest that the prevention or early diagnosis and treatment of serious infections in the elderly patient with a hip fracture remain an important challenge to clinicians.