Low Effort Memes

To further clarify expr's explanation, most people are familiar with new york only by way of new york city. Shockingly (/s), new york city, a city confined by small island and shoreline with a population of 8 million+, is an entirely different beast than the entire state with a slightly larger population. So people generally differentiate upstate new york with the moniker to explicitly refer to how it is different; mainly being rather rural outside of the 'minor' metropolitan areas like albany. The 'up' part is because most folks think of north as 'up' due to maps being oriented that way.