The aim of this study was to examine the participation and performance trends in wheelchair marathon for wheelchair (WC) and hand cycle (HC) athletes. Age and time performance data for all athletes in the WC and HC categories who completed the "New York City Marathon" from 1999 to 2010 were analyzed. During this period, there were 698 total finishers (132 women and 566 men) for WC athletes and 776 total finishers (141 women and 635 men) for HC athletes. Women accounted for ~20% of the total field for both categories. For both men and women, the age of the winner and the mean age of all finishers were significantly (P < 0.01) younger for WC compared with HC athletes. For men, the race times were significantly (P < 0.01) shorter for the HC winner and overall finishers compared with WC counterpart. Since 2003, the sex difference in time performances for WC athletes stabilized at ~25%, while the sex difference for HC athletes was more variable (15-45%). Future studies need to investigate the reasons why HC marathoners are older than WC marathoners and why the sex differences in marathon performance are much greater for disabled athletes than for able-bodied athletes.