Skip to main content


Log in

Beyond the grey tsunami: a cross-sectional population-based study of multimorbidity in Ontario

  • Quantitative Research
  • Published:
Canadian Journal of Public Health Aims and scope Submit manuscript



To determine volumes and rates of multimorbidity in Ontario by age group, sex, material deprivation, and geography.


A cross-sectional population-based study was completed using linked provincial health administrative databases. Ontario residents were classified as having multimorbidity (3+ chronic conditions) or not, based on the presence of 17 chronic conditions. The volumes (number of residents) of multimorbidity were determined by age categories in addition to crude and age-sex standardized rates.


Among the 2013 Ontario population, 15.2% had multimorbidity. Multimorbidity rates increased across successively older age groups with lowest rates observed in youngest (0–17 years, 0.2%) and highest rates in the oldest (80+ years, 73.5%). The rate of multimorbidity increased gradually from ages 0 to 44 years, with a substantial and graded increase in the rates as the population aged. The top five chronic conditions, of the 17 examined, among those with multimorbidity were mood disorders, hypertensive disorders, asthma, arthritis, and diabetes.


Much of the common rhetoric around multimorbidity concerns the aging ‘grey tsunami’. This study demonstrated that the volume of multimorbidity is derived from adults beginning as young as age 35 years old. A focus only on the old underestimates the absolute burden of multimorbidity on the health care system. It can mask the association of material deprivation and geography with multimorbidity which can turn our attention away from two critical issues: (1) potential inequality in health and health care in Ontario and (2) preventing younger and middle-aged people from moving into the multimorbidity category.



Déterminer les volumes et les taux de multimorbidité en Ontario selon le groupe d’âge, le sexe, la défavorisation matérielle et la géographie.


Une étude populationnelle transversale a été exécutée en maillant des bases de données administratives de santé provinciales. Les résidents de l’Ontario ont été catégorisés comme ayant ou non des multimorbidités (3 états chroniques ou plus) en fonction de la présence de 17 états chroniques. Les volumes (nombre de résidents) de multimorbidité ont été déterminés par catégorie d’âge en plus des taux bruts et des taux standardisés pour l’âge et le sexe.


Dans la population ontarienne de 2013, 15,2% des gens étaient atteints de multimorbidités. Les taux de multimorbidité augmentaient avec chaque groupe d’âge, les taux les plus faibles étant observés chez les plus jeunes (0-17 ans : 0,2%), et les taux les plus élevés, chez les plus âgés (80 ans et plus : 73,5%). Le taux de multimorbidité augmentait progressivement entre 0 et 44 ans, avec une hausse graduelle considérable dans les taux avec l’âge de la population. Sur les 17 états chroniques compris dans l’étude, les 5 états les plus courants chez les personnes atteintes de multimorbidités étaient les troubles de l’humeur, les troubles hypertensifs, l’asthme, l’arthrite et le diabète.


Le discours sur la multimorbidité s’articule principalement autour du « tsunami gris » du vieillissement. Notre étude démontre que le volume de multimorbidité comprend des adultes aussi jeunes que 35 ans. La restriction des études aux seules personnes âgées sous-estime le fardeau absolu de la multimorbidité sur le système de soins de santé. Elle peut masquer l’association entre la défavorisation matérielle ou la géographie et les multimorbidités, ce qui peut détourner notre attention de deux questions névralgiques : 1) les inégalités possibles sur le plan de la santé et des soins de santé en Ontario et 2) comment empêcher les jeunes et les personnes d’âge moyen de passer dans la catégorie des personnes atteintes de multimorbidités.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


Download references


This study was supported by the ICES Western site through participation in the ICES Western Faculty Scholar’s Program. Support for Dr. Bridget Ryan’s participation in the ICES Western Faculty Scholars Program came from the Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University. Dr. Ryan was also funded by the Canadian Institutes of Health Research Community-based Primary Health Care Innovation Team, Patient-centred Innovations for Persons with Multimorbidity.

ICES is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Core funding for ICES Western is provided by the Academic Medical Organization of Southwestern Ontario, the Schulich School of Medicine & Dentistry, Western University and the Lawson Health Research Institute.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Bridget L. Ryan.

Ethics declarations

This study was approved by the institutional review board at Sunnybrook Health Sciences Centre, Toronto, Canada.

Conflict of interest

The authors declare that they have no conflicts of interest.


This project was conducted at the Institute for Clinical Evaluative Sciences (ICES) Western Site. These datasets were linked using unique encoded identifiers and analyzed at the Institute for Clinical Evaluative Sciences (ICES). The data were analyzed by Britney Allen, MSc (Biostatistician at ICES Western). Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors, and not necessarily those of CIHI or the other funding sources. No endorsement by CIHI or the other funding sources is intended or should be inferred.

Electronic supplementary material


(DOCX 17 kb)


(DOCX 17 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ryan, B.L., Bray Jenkyn, K., Shariff, S.Z. et al. Beyond the grey tsunami: a cross-sectional population-based study of multimorbidity in Ontario. Can J Public Health 109, 845–854 (2018).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: