The Coogee man collapsed and went into cardiac arrest near the annual fun run's Bondi finishing line just before 11am (AEST) on Sunday.
"He passed away at the hospital, shortly after arriving," a St Vincent's Hospital spokesman told AAP.
Race organisers have called the man's death "a moment of enormous sadness" and say their thoughts are with his loved ones.
ABC reporter Anne Barker saw the events unfold from the finish line.
"I turned around and saw him almost crawling, clearly in trouble, but still trying to reach the line. He was barely a metre away," she told the ABC.
"He was very white. Suddenly he just collapsed on the ground, rolled on his side and stopped moving.
"Ambulance officers ran over, put him on a stretcher and by then he was obviously unconscious.
"It was all the more distressing because runners were just streaming past him, so clearly happy to have finished, many unaware of what had happened."
It was a tragic turn for the world's biggest fun run, which this
year raised more than $4 million for charity.
More than 80,000 people took part in the gruelling 14km race from Sydney's CBD to Bondi Beach - by way of the infamous "Heartbreak Hill".
Olympic long-distance runner Craig Mottram won the race, crossing the finish line in 41 minutes and 56 seconds in his first attempt at the iconic running event.
FUN RUN TURNS TO TRAGEDY
2014 - A 27-year-old Coogee man goes into cardiac arrest metres from the finish line and is rushed to hospital. He dies a short time later.
2008 - British national Lee Marriage, 26, collapses just 200m from the finish line at Bondi Beach and cannot be revived. He is later described by loved ones as "extremely fit".
2000 - A man believed to be in his late 30s collapses about 11.10am in Vaucluse and does not recover. Witnesses report the man appeared to suffer a heart attack and struck his head heavily as he fell.
1995 - A 19-year-old runner, Andrew Evan Wellard of Canley Heights, finishes the 14-kilometre race in 60 minutes. But he suffers two cardiac episodes after crossing the finish line, and dies 10 days later. Police later reveal he had a mild case of flu when he attempted the race.
1990 - Two runners in their 20s die of heat exhaustion.
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