Healthcare Equity in Vitiligo Management: A Comparative Cross-Sectional Analytical Study of Patients Profiles, Clinical Outcomes, and Quality of Life in Public versus Private Hospitals in Kandahar, Afghanistan

BackgroundHealthcare system disparities have a significant impact on chronic disease management in conflict-affected settings. Vitiligo, a stigmatizing dermatological condition, requires sustained care, yet limited evidence exists regarding how healthcare sector differences affect patient outcomes in Afghanistan. This study addresses this critical knowledge gap in a post-conflict, resource-limited setting. The main objectives of this study were to compare socio-demographic profiles, clinical characteristics, psychological burden, and health-related quality of life (HRQoL) between vitiligo patients attending public versus private hospitals in Kandahar, Afghanistan. MethodsA cross-sectional analytical study was conducted from March 2023 to January 2024 with 402 vitiligo patients (153 [38.1%] from three public hospitals and 249 [61.9%] from five private hospitals). Comprehensive assessment included socio-demographic variables, clinical severity (Vitiligo Area Severity Index [VASI]), psychological distress (General Health Questionnaire-12 [GHQ-12]), anxiety (Hamilton Anxiety Rating Scale [HAM-A]), depression (Quick Inventory of Depressive Symptomatology [QIDS-SR16]), and HRQoL (Dermatology Life Quality Index [DLQI]). Stratified analyses, multivariable linear regression, and interaction testing were performed. ResultsCompared to public hospitals, patients visiting private hospitals were younger (69.3% aged 18- 29 years, {chi}2=21.4, p<0.001), more rural (65.5%, {chi}2=12.7, p<0.001), and less educated (63.9% illiterate, {chi}2=15.2, p<0.001). However, clinical severity (VASI: public M=6.58{+/-}7.47; private M=6.84{+/-}4.64; t=-0.427, p=0.670), psychological burden, and HRQoL showed no significant differences between sectors. Interaction analyses revealed moderating effects: disease severity impacted HRQoL more strongly in public hospitals (VASIxhospital type: B=-0.168, 95%CI: - 0.258 to -0.077, p<0.001, {beta}=-0.515), while psychological distress affected HRQoL more in private settings (GHQxhospital type: B=0.440, 95%CI: 0.094 to 0.785, p=0.013, {beta}=0.442). ConclusionWhile demographic disparities exist in healthcare access, clinical and psychological outcomes are similar across sectors. However, pathways to HRQoL impairment differ significantly, suggesting sector-specific mechanisms requiring tailored interventions. These findings highlight the need for equitable, context-sensitive vitiligo care that addresses both universal and sector-specific determinants of patient well-being in conflict-affected settings.