The median household income in Jefferson County, Texas is $51,000. The median home price is $135,000. That's under 3x.

The median household income in San Francisco is $120,000, but the median home price is $1.5-2 million, depending on source. That's 12-16x.

A $500/month truck payment isn't putting people on the edge of financial ruin when you're talking about an $800/month mortgage versus a $6,500/month mortgage.

In towns whose livelihood depends on a feast-or-famine industry like oil, yes. In cities with strong, diversified economies, it's just people spending disposable income on stuff they want.