However, the US also has the largest number of severely unaffordable major housing markets for all of the countries covered by the survey.
The Demographia study looked at 293 metropolitan housing markets in Australia, Canada, China, Ireland, Japan, New Zealand, Singapore, the United Kingdom, and the US for the third quarter of 2017.
The study uses a median multiple, which is the median house price divided by the median household income, to rate middle-income housing affordability.
The survey only found 10 affordable major housing markets, and all are US cities. With a median multiple of 2.5, Rochester, N.Y., was the most affordable. Cincinnati and Cleveland followed with 2.7 multiples. Oklahoma City; Pittsburgh; Buffalo, N.Y.; St. Louis; Detroit; Indianapolis; and Grand Rapids; Mich. made up the rest of the top 10.
Meanwhile, 13 of the major markets in the US were severely unaffordable. The study found 28 severely unaffordable major housing markets.
US cities among the top 10 least affordable markets were San Jose, Calif., which was in fourth place with a median multiple of 10.3; Los Angeles, with 9.4; Honolulu, with 9.2; and San Francisco, with 9.1.
The study again found Hong Kong as the least affordable, with a median multiple of 19.4 up from 18.1 last year.
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There are only 10 affordable major housing markets in the world, and all cities are found in the US, according to the Demographia International Housing Affordability Survey.