A historically significant region, the area included the mound building native culture of Cahokia, and the later French settlements of the Illinois Country.

The Metro East is a loose collection of small and mid-sized cities sitting along the American Bottom and the bluffs of the Mississippi River.

German speakers exist in southeastern Madison, and Clinton, and southern and eastern St. Clair Counties.

The largest concentration of African-Americans is in Madison, Venice, western Granite City, East St. Louis, Washington Park, Belleville, Cahokia, Alorton and Alton.

In 2019, the St. Clair County Transit District was awarded $96 million in Illinois infrastructure funding to build a 5.2-mile (8.4 km) extension of the Red Line from Shiloh-Scott to MidAmerica St. Louis Airport in Mascoutah.

Laurell K. Hamilton has used the Metro East as a setting in several books from the Anita Blake and Merry Gentry series.