VANCOUVER -- For the second year in a row, Vancouver has ranked as the second-most unaffordable housing market in the world.

That’s according to the 16th annual Demographia International Housing Affordability Survey, which looks at middle-income housing affordability.

Hong Kong topped the list for the tenth year, and Sydney came in third.

What do the numbers means?

Demographia rates middle-income housing affordability using what it calls, the "median multiple," which is the median house price divided by the median household income. For 2020, Vancouver was given a score of 11.9, indicating the median house price is almost 12 times more than the median household income.

Hong Kong, Vancouver and Sydney are all accustomed to being the top three cities on the list. The last four years have looked like this:

Hong Kong 20.8
Vancouver 11.9
Sydney 11

Hong Kong 20.9
Vancouver 12.6
Sydney 11.7

Hong Kong 19.4
Sydney 12.9
Vancouver 12.6

Hong Kong 18.1
Sydney 12.2
Vancouver 11.8

For analysis, CTV News spoke with Andy Yan, the director of the city program at Simon Fraser University.

"It reflects, really, the ongoing challenges when it comes to affordable housing in metropolitan Vancouver whether it be rental or home ownership," he said.

He said it also comes down to incomes and wage growth.

"They’ve grown a little bit but nowhere close to the kind of gains you seen in terms of housing values and increases in rents," he said.

The provincial government has made legislative changes in an effort to ease the inflated market with the introduction of the foreign buyers' tax and the empty homes tax.

"They’ve certainly had an effect," Yan said. "It probably will still take another two or three years more before we’ll see the kind of final effect of these kinds of policies."

Angie Coppersmith has lived in Vancouver since the 1990s. "I came here in 1997 from Montreal, originally from London, and I found it expensive then," she told CTV News. "You’re paying for paradise, I guess. One week of winter and look at the rest of the country. I guess it’s a sacrifice."

That sentiment was echoed by Annabelle Stiven, who’s lived in Vancouver for seven years. "It makes economic sense to move somewhere like Calgary where the housing’s cheaper," she said. "If I didn’t enjoy living in Vancouver, I would live somewhere else."

Will Vancouver ever become affordable?

Yan says the generally accepted rating for "affordable" is when house prices are within three to five times that of household income. But for Vancouver to reach that "either the need to double incomes, household incomes, median household incomes, or ensure that housing prices go in half," he said.