While there is no widely agreed upon definition, the Downstate region, like Upstate New York, is considered to consist of several subregions, such as New York City, Long Island, the Lower Hudson Valley, and (to varying degrees of inclusion), the Mid-Hudson Valley and Catskill Mountains areas.
Both agencies and the general public use varying definitions of the boundary between Upstate and Downstate.
Despite being a very small portion of the state's total land area, the Downstate region contains approximately two-thirds of New York's entire population.
Its layout is largely urban and suburban, and constitutes New York State's portion of the New York metropolitan area, the world's largest urban landmass.
One official usage of the term is by the State University of New York ("SUNY") system in the name of its southernmost medical school, SUNY Downstate Medical Center, located in East Flatbush, Brooklyn.