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Objectives To estimate the attributable costs of multimorbidity and assess whether the association between the level of multimorbidity and health system costs varies by socio-demographic factors in young (< 65 years) and older (≥ 65 years) adults living in Ontario, Canada. Design A population-based, retrospective cohort study Setting The province of Ontario, Canada Participants 6 639 089 Ontarians who were diagnosed with at least one of 16 selected medical conditions on 1 April 2009. Main outcome measures From the perspective of the publicly funded healthcare system, total annual healthcare costs were derived from linked provincial health administrative databases using a person-level costing method. We used generalised linear models to examine the association between the level of multimorbidity and healthcare costs and the extent to which socio-demographic variables modified this association …